Pham S M, Kormos R L, Landreneau R J, Kawai A, Gonzalez-Cancel I, Hardesty R L, Hattler B G, Griffith B P
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
Ann Thorac Surg. 1995 Dec;60(6):1623-6. doi: 10.1016/0003-4975(95)00120-4.
Prolonged nonspecific immunosuppression after solid-organ transplantation is associated with an increased risk of certain cancers. This study examined the development of solid-organ tumors after cardiac transplantation.
Thirty-eight solid tumors were identified in 36 (5.9%) of 608 cardiac transplant recipients who survived more than 30 days. Two patients had two types of skin tumors (basal cell and squamous cell). The tumors included the following types: skin (15), lung (10), breast (1), bladder (2), larynx (2), liver (1), parotid (1), testicle (1), uterus (2), melanoma (2), and Merkel's cell (1). Four immunosuppression regimens based on cyclosporin A or FK 506 were used during this period.
There was no association between the incidence of solid tumors and the use of lympholytic therapy. After the diagnosis of tumor was made, the actuarial 2-year survival rates of recipients with skin, lung, and other solid tumors were 71%, 22%, and 23%, respectively. Eight of 10 patients with lung cancer were in stage IIIA or higher at the time of diagnosis.
Skin and lung tumors are the most frequent solid tumors in heart transplant recipients. Skin tumors (except Merkel's cell carcinoma and melanoma) usually have a benign course, whereas lung and other tumors developing in cardiac transplant recipients carry a poor prognosis. Advanced disease stage at the time of diagnosis is responsible for the dismal outcome of recipients in whom solid tumors develop. Close postoperative tumor surveillance after cardiac transplantation is warranted.
实体器官移植后长期的非特异性免疫抑制与某些癌症风险增加相关。本研究调查了心脏移植后实体器官肿瘤的发生情况。
在608例存活超过30天的心脏移植受者中，36例（5.9%）被确诊患有38种实体肿瘤。两名患者患有两种皮肤肿瘤（基底细胞癌和鳞状细胞癌）。肿瘤类型包括：皮肤（15例）、肺（10例）、乳腺（1例）、膀胱（2例）、喉（2例）、肝脏（1例）、腮腺（1例）、睾丸（1例）、子宫（2例）、黑色素瘤（2例）和默克尔细胞癌（1例）。在此期间使用了四种基于环孢素A或FK 506的免疫抑制方案。
实体肿瘤的发生率与使用淋巴细胞溶解疗法之间无关联。肿瘤确诊后，皮肤、肺和其他实体肿瘤受者的2年精算生存率分别为71%、22%和23%。10例肺癌患者中有8例在诊断时处于IIIA期或更高分期。
皮肤和肺肿瘤是心脏移植受者中最常见的实体肿瘤。皮肤肿瘤（默克尔细胞癌和黑色素瘤除外）通常病程良性，而心脏移植受者中发生的肺和其他肿瘤预后较差。诊断时疾病分期较晚是实体肿瘤发生的受者预后不良的原因。心脏移植术后应进行密切的肿瘤监测。
