Spectrum of Cancer Risk Among US Solid Organ Transplant Recipients

被引：1147

作者：

Engels, Eric A. ^{[1
]}

Pfeiffer, Ruth M. ^{[1
]}

Fraumeni, Joseph F., Jr. ^{[1
]}

Kasiske, Bertram L. ^{[2
,3
]}

Israni, Ajay K. ^{[2
,3
]}

Snyder, Jon J. ^{[2
,3
]}

Wolfe, Robert A. ^{[4
,5
]}

Goodrich, Nathan P. ^{[4
,5
]}

Bayakly, A. Rana ^{[6
]}

Clarke, Christina A. ^{[7
]}

Copeland, Glenn ^{[8
]}

Finch, Jack L. ^{[9
]}

Fleissner, Mary Lou ^{[10
]}

Goodman, Marc T. ^{[11
]}

Kahn, Amy ^{[12
]}

Koch, Lori ^{[13
]}

Lynch, Charles F. ^{[14
]}

Madeleine, Margaret M. ^{[15
]}

Pawlish, Karen ^{[16
]}

Rao, Chandrika ^{[17
]}

Williams, Melanie A. ^{[18
]}

Castenson, David ^{[19
]}

Curry, Michael ^{[19
]}

Parsons, Ruth ^{[19
]}

Fant, Gregory ^{[20
]}

Lin, Monica ^{[20
]}

机构：

[1] NCI, Rockville, MD 20892 USA

[2] Sci Registry Transplant Recipients, Minneapolis, MN USA

[3] Minneapolis Med Res Fdn Inc, Minneapolis, MN USA

[4] Sci Registry Transplant Recipients, Ann Arbor, MI USA

[5] Arbor Res Collaborat Hlth, Ann Arbor, MI USA

[6] Georgia Comprehens Canc Registry, Atlanta, GA USA

[7] Canc Prevent Inst Calif, Fremont, CA USA

[8] Michigan Dept Community Hlth, Lansing, MI USA

[9] Colorado Cent Canc Registry, Denver, CO USA

[10] Connecticut Tumor Registry, Hartford, CT USA

[11] Univ Hawaii, Program Epidemiol, Honolulu, HI 96822 USA

[12] New York State Canc Registry, Albany, NY USA

[13] Illinois State Canc Registry, Springfield, IL USA

[14] Univ Iowa, Dept Epidemiol, Iowa City, IA USA

[15] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA

[16] New Jersey Dept Hlth & Senior Serv, Trenton, NJ USA

[17] N Carolina Cent Canc Registry, Raleigh, NC USA

[18] Texas Dept State Hlth Serv, Austin, TX USA

[19] Informat Management Serv Inc, Rockville, MD USA

[20] US Hlth Resources & Serv Adm, Rockville, MD 20857 USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2011年 / 306卷 / 17期

关键词：

UNITED-STATES; KIDNEY-TRANSPLANTATION; BRONCHOGENIC-CARCINOMA; LIVER-TRANSPLANTATION; RENAL-TRANSPLANTATION; LUNG TRANSPLANTATION; CELL CARCINOMA; DISEASE; PEOPLE; AGENTS;

D O I：

10.1001/jama.2011.1592

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Context Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology. Objective To describe the overall pattern of cancer following solid organ transplantion. Design, Setting, and Participants Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries. Main Outcome Measures Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population. Results The registry linkages yielded data on 175 732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10 656 cases and an incidence of 1375 per 100 000 person-years (SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] per 100 000 person-years). Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (n=1504; incidence: 194.0 per 100 000 person-years; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] per 100 000 person-years) and cancers of the lung (n=1344; incidence: 173.4 per 100 000 person-years; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] per 100 000 person-years), liver (n= 930; incidence: 120.0 per 100 000 person-years; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] per 100 000 person-years), and kidney (n= 752; incidence: 97.0 per 100 000 person-years; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] per 100 000 person-years). Lung cancer risk was most elevated in lung recipients (SIR, 6.13 [95% CI, 5.18-7.21]) but also increased among other recipients (kidney: SIR, 1.46 [95% CI, 1.34-1.59]; liver: SIR, 1.95 [95% CI, 1.74-2.19]; and heart: SIR, 2.67 [95% CI, 2.40-2.95]). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 [95% CI, 40.90-46.91]), who manifested exceptional risk in the first 6 months (SIR, 508.97 [95% CI, 474.16-545.66]) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 [95% CI, 1.57-3.04]). Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 [95% CI, 6.12-7.23]) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 [95% CI, 1.40-2.29]) and heart recipients (SIR, 2.90 [95% CI, 2.32-3.59]). Conclusion Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers. JAMA. 2011; 306(17): 1891-1901

引用

页码：1891 / 1901

页数：11

共 39 条

[1]

Incidence of primary neoplasms in explanted lungs: Long-term follow-up from 214 lung transplant patients [J].