Jain A B, Yee L D, Nalesnik M A, Youk A, Marsh G, Reyes J, Zak M, Rakela J, Irish W, Fung J J
Division of Transplantation Surgery, University of Pittsburgh, Pennsylvania, USA.
Transplantation. 1998 Nov 15;66(9):1193-200. doi: 10.1097/00007890-199811150-00014.
An increased incidence of de novo nonlymphoid malignancies has been shown in immunocompromised patients. However, the true risk over time compared to the general population has not been determined.
One thousand consecutive patients were carefully followed for an average of 77.8+/-11.1 (range, 56.3-96.3) months after primary liver transplantation at a single center. All de novo nonlymphoid malignancies were recorded. Each malignancy was compared with a standard Occupational Cohort Mortality Analysis Program population matched for age, sex, and length of follow-up using modified life table technique and surveillance epidemiology end result (SEER) data.
Fifty-seven patients accounted for de novo malignancies and contributed 4795.3 total person years, a mean+/-SD of 36+/-21 (median, 36; range, 6-74) months after liver transplantation. Twenty-two of these malignancies were skin malignancies including two melanomas. Oropharyngeal cancers (n=7) were found to be 7.6 times higher (P<0.05) and respiratory malignancies (n=8) were 1.7 times higher (P>0.05) compared to the SEER incidence rate. Female reproductive system malignancies including breast cancer (n=3) were 1.9 times lower (P>0.05) and genitourinary malignancies were (n=5) 1.5 times lower (P>0.05) than their matched cohorts. No differences was observed in gastrointestinal malignancies (n=5). There was a significant difference in survival of the patients after diagnosis of malignancy depending on the type of cancer. There were two Kaposi's sarcomas, two metastatic unknown primaries, one thyroid, one brain, and one ophthalmic malignancies in the series. Mortality for Kaposi's and metastatic disease of unknown primary was 100% within 5 months, while the 1-year mortality for oropharyngeal cancer was 57.1% and that for lung cancers was 62.5%. Long-term survival for skin cancer was highest: 86.4% at 3 years (P=0.015 by log-rank test).
An increased incidence of de novo cancers in the chronically immunocompromised patient demands careful long-term screening protocols which will help to facilitate the diagnosis at an early stage of the disease. This is particularly true for oropharyngeal cancers where the risk is more than 7 times higher compared to SEER incidence data matched for age, sex, and length of follow-up.
免疫功能低下患者新发非淋巴系统恶性肿瘤的发病率有所增加。然而，与普通人群相比，其随时间推移的真实风险尚未确定。
在单一中心，对1000例连续接受原发性肝移植的患者进行了平均77.8±11.1（范围56.3 - 96.3）个月的密切随访。记录所有新发非淋巴系统恶性肿瘤。使用改良生命表技术和监测流行病学最终结果（SEER）数据，将每种恶性肿瘤与年龄、性别和随访时间匹配的标准职业队列死亡率分析程序人群进行比较。
57例患者发生了新发恶性肿瘤，共贡献4795.3人年，肝移植后平均±标准差为36±21（中位数36；范围6 - 74）个月。其中22例为皮肤恶性肿瘤，包括2例黑色素瘤。与SEER发病率相比，口咽癌（n = 7）高出7.6倍（P < 0.05），呼吸道恶性肿瘤（n = 8）高出1.7倍（P > 0.05）。包括乳腺癌（n = 3）在内的女性生殖系统恶性肿瘤比其匹配队列低1.9倍（P > 0.05），泌尿生殖系统恶性肿瘤（n = 5）低1.5倍（P > 0.05）。胃肠道恶性肿瘤（n = 5）未观察到差异。根据癌症类型，恶性肿瘤诊断后患者的生存率存在显著差异。该系列中有2例卡波西肉瘤、2例转移性原发灶不明肿瘤、1例甲状腺癌、1例脑癌和1例眼部恶性肿瘤。卡波西肉瘤和原发灶不明转移性疾病的死亡率在5个月内为100%，而口咽癌的1年死亡率为57.1%，肺癌为62.5%。皮肤癌的长期生存率最高：3年时为86.4%（对数秩检验P = 0.015）。
慢性免疫功能低下患者新发癌症发病率增加，需要仔细的长期筛查方案，这将有助于在疾病早期阶段促进诊断。对于口咽癌尤其如此，其风险比年龄、性别和随访时间匹配的SEER发病率数据高出7倍多。
