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实体器官移植受者的皮肤鳞状细胞癌:当前的治疗和筛查策略。

Cutaneous squamous cell carcinoma in solid organ transplant recipients: Current therapeutic and screening strategies.

机构信息

Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.

出版信息

Transplant Rev (Orlando). 2024 Dec;38(4):100882. doi: 10.1016/j.trre.2024.100882. Epub 2024 Sep 25.

Abstract

Solid organ transplant recipients (SOTRs) are particularly prone to developing malignancies, often manifesting multiple tumors and tumors with a heightened susceptibility to metastasis, resulting in much lower survival rates when compared to the general population. Among these, cutaneous squamous cell carcinoma (CSCC) respresent a major challenge in terms of morbidity and mortality following organ transplantation. The management of post-transplant CSCC requires expertise from various disciplines, including dermatology, maxillofacial surgery, transplant medicine, radiation oncology, and medical oncology. Furthermore, the unique behaviors and prevalence of tumors in SOTRs necessitate tailored pathways for screening and treatment, distinct from those designed for immunocompetent patients. Despite the proven efficacy of immune checkpoint inhibitors (ICIs) in several cancers, SOTRs have often been systematically excluded from clinical trials due to concerns about potential allograft rejection and loss. Consequently, most data on the safety and efficacy of ICIs in SOTRs are derived from case series and reports. Given the significant risks involved, alternative therapeutic options should be thoroughly discussed with patients before considering ICI therapy. This literature review aims to provide an overview of CSCC in SOTRs, with a specific emphasis on therapeutic and screening strategies, particularly highlighting immunotherapy.

摘要

实体器官移植受者(SOTR)特别容易发生恶性肿瘤,常表现为多发肿瘤和易发生转移的肿瘤,与普通人群相比,其生存率要低得多。在这些肿瘤中,皮肤鳞状细胞癌(CSCC)在器官移植后发病率和死亡率方面构成了重大挑战。移植后 CSCC 的管理需要皮肤科、颌面外科、移植医学、放射肿瘤学和肿瘤内科等多个学科的专业知识。此外,SOTR 中的肿瘤具有独特的行为和流行特征,需要针对筛查和治疗制定专门的途径,与针对免疫功能正常患者的途径不同。尽管免疫检查点抑制剂(ICI)在几种癌症中的疗效已得到证实,但由于担心潜在的同种异体排斥和丢失,SOTR 经常被系统地排除在临床试验之外。因此,ICI 在 SOTR 中的安全性和疗效的大多数数据均源自病例系列和报告。鉴于存在重大风险,在考虑 ICI 治疗之前,应与患者充分讨论替代治疗方案。本文献综述旨在概述 SOTR 中的 CSCC,重点介绍治疗和筛查策略,特别是免疫疗法。

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