Montagnino G, Lorca E, Tarantino A, Bencini P, Aroldi A, Cesana B, Braga M, Lonati F, Ponticelli C
Divisione di Nefrologia e Dialisi, Ospedale Maggiore IRCCS, Universita' di Milano, Milan, Italy.
Clin Transplant. 1996 Oct;10(5):461-9.
In this retrospective historical study, we compared the incidences of malignancies observed among 854 renal transplant recipients (RT) with at least 1 yr of follow-up, with the incidences of neoplasias among patients under regular dialytic treatment (RDT) and a control population from Northern Italy. Cox's proportional hazard model was used in RT recipients in order to evaluate the prognostic factors related to the development of neoplasia. Seventy six out of 854 RT patients (8.9%) developed some malignant neoplasia: 46% of these 76 were cutaneous neoplasias including melanomas, and the remaining 54% non cutaneous cancers: 33% miscellaneous tumors (MT), mostly adenocarcinomas, 17% Kaposi's sarcomas (KS), 4% non-Hodgkin's lymphomas (NHL). Malignancies had a higher incidence (p < 0.01) among RT recipients than among control and RDT patients. However, MT were equally frequent among the three groups. RDT patients on the contrary, had similar incidence of neoplasias when compared to the control population, but showed a lower incidence of squamous cell carcinomas (SCC). The risk ratios (RR) for the most frequent neoplasias among RT recipients vs. control population were: 224.7 for KS, 7.4 for NHL, 6.2 for SCC, 5.7 for basal cell carcinomas (BCC), 4.0 for MT. The risk of developing a de novo neoplasia was of about 13% at 10 yr and of 34% at 20 yr. In RT recipients, Cox's proportional analysis showed that age > 40 at transplantation and male sex were the only risk factors associated with an increased incidence of neoplasias, while no difference was observed between conventional (azathioprine+methylprednisolone: Aza+MP) and CsA therapy or in CsA monotherapy vs. double or triple therapy. However, KS occurrence correlated both with CsA dose (RR 15.2 for monotherapy; 12.5 for double therapy; 2.98 for triple therapy) and with 10 or more i.v. methylprednisolone pulses for treatment of rejection (RR 5.2). We conclude that in our series CsA does not increase the risk for development of neoplasias, when compared to conventional immunosuppression.
在这项回顾性历史研究中，我们比较了854名接受至少1年随访的肾移植受者（RT）中观察到的恶性肿瘤发病率，与接受常规透析治疗（RDT）的患者以及意大利北部一个对照人群中的肿瘤发病率。在肾移植受者中使用Cox比例风险模型来评估与肿瘤发生相关的预后因素。854名肾移植患者中有76名（8.9%）发生了某种恶性肿瘤：这76例中的46%为皮肤肿瘤，包括黑色素瘤，其余54%为非皮肤癌：33%为其他肿瘤（MT），主要是腺癌，17%为卡波西肉瘤（KS），4%为非霍奇金淋巴瘤（NHL）。肾移植受者中恶性肿瘤的发病率高于对照组和接受常规透析治疗的患者（p < 0.01）。然而，其他肿瘤在三组中的发生率相当。相反，与对照人群相比，接受常规透析治疗的患者肿瘤发生率相似，但鳞状细胞癌（SCC）的发生率较低。肾移植受者中最常见肿瘤与对照人群相比的风险比（RR）为：KS为224.7，NHL为7.4，SCC为6.2，基底细胞癌（BCC）为5.7，其他肿瘤为4.0。10年时发生新发肿瘤的风险约为13%，20年时为34%。在肾移植受者中，Cox比例分析表明，移植时年龄>40岁和男性是与肿瘤发病率增加相关的唯一风险因素，而在传统治疗（硫唑嘌呤+甲基泼尼松龙：Aza+MP）和环孢素治疗之间以及环孢素单药治疗与双联或三联治疗之间未观察到差异。然而，卡波西肉瘤的发生与环孢素剂量（单药治疗的RR为15.2；双联治疗为12.5；三联治疗为2.98）以及用于治疗排斥反应的10次或更多次静脉注射甲基泼尼松龙脉冲相关（RR为5.2）。我们得出结论，在我们的系列研究中，与传统免疫抑制相比，环孢素不会增加肿瘤发生的风险。
