Haas Cameron B, Shiels Meredith S, Pfeiffer Ruth M, D'Arcy Monica, Luo Qianlai, Yu Kelly, Austin April A, Cohen Colby, Miller Paige, Morawski Bozena M, Pawlish Karen, Robinson William T, Engels Eric A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
New York State Cancer Registry, Albany, NY, USA.
J Natl Cancer Inst. 2024 Dec 1;116(12):1983-1991. doi: 10.1093/jnci/djae159.
Immunosuppressed individuals have elevated risk of virus-related cancers. Identifying cancers with elevated risk in people with HIV and solid organ transplant recipients, 2 immunosuppressed populations, may help identify novel etiologic relationships with infectious agents.
We used 2 linkages of population-based cancer registries with HIV and transplant registries in the United States. Cancer entities were systematically classified according to site and histology codes. Standardized incidence ratios were used to compare risk in people with HIV and solid organ transplant recipients with the general population. For selected cancer entities, incidence rate ratios were calculated for indicators of immunosuppression within each population.
We identified 38 047 cancer cases in solid organ transplant recipients and 53 592 in people with HIV, yielding overall standardized incidence ratios of 1.66 (95% confidence interval [CI] = 1.65 to 1.68) and 1.49 (95% CI = 1.47 to 1.50), respectively. A total of 43 cancer entities met selection criteria, including conjunctival squamous cell carcinoma (people with HIV standardized incidence ratio = 7.1, 95% CI = 5.5 to 9.2; solid organ transplant recipients standardized incidence ratio = 9.4, 95% CI = 6.8 to 12.6). Sebaceous adenocarcinoma was elevated in solid organ transplant recipients (standardized incidence ratio = 16.2, 95% CI = 14.0 to 18.6) and, among solid organ transplant recipients, associated with greater risk in lung and heart transplant recipients compared with recipients of other organs (incidence rate ratio = 2.3, 95% CI = 1.7 to 3.2). Salivary gland tumors, malignant fibrous histiocytoma, and intrahepatic cholangiocarcinoma showed elevated risk in solid organ transplant recipients (standardized incidence ratio = 3.9, 4.7, and 3.2, respectively) but not in people with HIV. However, risks for these cancers were elevated following an AIDS diagnosis among people with HIV (incidence rate ratio = 2.4, 4.3, and 2.0, respectively).
Elevated standardized incidence ratios among solid organ transplant recipients and people with HIV, and associations with immunosuppression within these populations, suggest novel infectious causes for several cancers including conjunctival squamous cell carcinoma, sebaceous adenocarcinoma, salivary gland tumors, malignant fibrous histiocytoma, and intrahepatic cholangiocarcinoma.
免疫抑制个体患病毒相关癌症的风险升高。在艾滋病病毒感染者和实体器官移植受者这两类免疫抑制人群中识别出风险升高的癌症，可能有助于确定与感染因子的新型病因关系。
我们利用了美国基于人群的癌症登记处与艾滋病病毒和移植登记处的两个关联数据。癌症实体根据部位和组织学编码进行系统分类。标准化发病率比用于比较艾滋病病毒感染者和实体器官移植受者与普通人群的风险。对于选定的癌症实体，计算了各人群中免疫抑制指标的发病率比。
我们在实体器官移植受者中识别出38047例癌症病例，在艾滋病病毒感染者中识别出53592例，总体标准化发病率比分别为1.66（95%置信区间[CI]=1.65至1.68）和1.49（95%CI=1.47至1.50）。共有43种癌症实体符合选择标准，包括结膜鳞状细胞癌（艾滋病病毒感染者标准化发病率比=7.1，95%CI=5.5至9.2；实体器官移植受者标准化发病率比=9.4，95%CI=6.8至12.6）。皮脂腺腺癌在实体器官移植受者中发病率升高（标准化发病率比=16.2，95%CI=14.0至18.6），在实体器官移植受者中，与肺和心脏移植受者相比，其他器官移植受者的风险更高（发病率比=2.3，95%CI=1.7至3.2）。唾液腺肿瘤、恶性纤维组织细胞瘤和肝内胆管癌在实体器官移植受者中显示出风险升高（标准化发病率比分别为3.9、4.7和3.2），但在艾滋病病毒感染者中未升高。然而，在艾滋病病毒感染者中，艾滋病诊断后这些癌症的风险升高（发病率比分别为2.4、4.3和2.0）。
实体器官移植受者和艾滋病病毒感染者的标准化发病率比升高，以及这些人群中与免疫抑制的关联，提示包括结膜鳞状细胞癌、皮脂腺腺癌、唾液腺肿瘤、恶性纤维组织细胞瘤和肝内胆管癌在内的几种癌症有新的感染病因。
