CANCER RISK AFTER RENAL-TRANSPLANTATION IN THE NORDIC COUNTRIES, 1964-1986

被引:472
作者
BIRKELAND, SA
STORM, HH
LAMM, LU
BARLOW, L
BLOHME, I
FORSBERG, B
EKLUND, B
FJELDBORG, O
FRIEDBERG, M
FRODIN, L
GLATTRE, E
HALVORSEN, S
HOLM, NV
JAKOBSEN, A
JORGENSEN, HE
LADEFOGED, J
LINDHOLM, T
LUNDGREN, G
PUKKALA, E
机构
[1] ODENSE UNIV HOSP,DEPT NEPHROL,DK-5000 ODENSE,DENMARK
[2] ODENSE UNIV HOSP,TISSUE CULTURE LAB,DK-5000 ODENSE,DENMARK
[3] SKEJBY UNIV HOSP,DEPT CLIN IMMUNOL,SKEJBY,DENMARK
[4] CANC REGISTRY,STOCKHOLM,SWEDEN
[5] SAHLGRENS UNIV HOSP,DIV TRANSPLANTAT & LIVER SURG,S-41345 GOTHENBURG,SWEDEN
[6] MALMO GEN HOSP,DEPT MED,NEPHROL SECT,S-21401 MALMO,SWEDEN
[7] UNIV HELSINKI,CENT HOSP,DEPT SURG 9,HELSINKI,FINLAND
[8] SKEJBY UNIV HOSP,DEPT UROL,TRANSPLANTAT SURG SECT,SKEJBY,DENMARK
[9] HVIDOVRE MUNICIPAL HOSP,DEPT NEPHROL,HVIDOVRE,DENMARK
[10] ACAD HOSP,DEPT UROL,TRANSPLANTAT SECT,UPPSALA,SWEDEN
[11] ACAD HOSP,DEPT SURG,UPPSALA,SWEDEN
[12] CANC REGISTRY NORWAY,OSLO,NORWAY
[13] ULLEVAL HOSP,DEPT 7,OSLO,NORWAY
[14] ODENSE UNIV,INST COMMUNITY HLTH,HVIDOVRE,DENMARK
[15] NATL HOSP NORWAY,DEPT SURG B,OSLO,NORWAY
[16] HERLEV CTY HOSP,DEPT NEPHROL B,COPENHAGEN,DENMARK
[17] STATE UNIV HOSP COPENHAGEN,COPENHAGEN,DENMARK
[18] UNIV LUND HOSP,DEPT NEPHROL,S-22185 LUND,SWEDEN
[19] HUDDINGE HOSP,DEPT TRANSPLANTAT SURG,S-14186 HUDDINGE,SWEDEN
[20] FINNISH CANC REGISTRY,SF-00170 HELSINKI,FINLAND
关键词
D O I
10.1002/ijc.2910600209
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The theory that cancer may arise under conditions of reduced immune capacity is supported by observations of humans with immune deficiencies such as occur following organ transplants. However, no study on humans has been done in which the reference population was the same as that in which the cancer cases arose and in which there was a sufficiently long period of follow-up. Information on 5,692 Nordic recipients of renal transplants in 1964-1982 was linked with the national cancer registries (1964-1986) and population registries. Person-years at risk were calculated from the date of first transplantation until death or the end of the study period and were multiplied by the appropriate age- and calender-specific incidence rates to obtain the expected numbers of cancers. Standardized incidence ratios (SIR) were calculated after stratification by a number of recorded variables. Altogether, 32,392 person-years were accrued, and 471 cancers occurred, yielding overall SIR of 4.6 (95% CI, 4.0 to 5.2) for males and 4.5 (95% CI, 4.0 to 5.2) for females. Significant overall 2- to 5-fold excess risks in both sexes were seen for cancers of the colon, larynx, lung and bladder, and in men also far cancers of the prostate and testis. Notably high risks, 10-fold to 30-fold above expectation, were associated with cancers of the lip, skin (non-melanoma), kidney and endocrine glands, also with non-Hodgkin's lymphoma, and in women also with cancers of the cervix and vulva-vagina. Among a number of donor and recipient variables studied, including tissue types and compatibility (ABO, HLA, DR), age below 45 years at the time of transplantation was the most important determinant for increased risk at most sites. Kidney transplantation increases the risk of cancer in the short and in the long term, consistent with the theory that an impaired immune system allows carcinogenic factors to act. The tumor risk is small in comparison with the benefits of transplants, but patients should be followed up for signs of cancer. (C) 1995 Wiley-Liss, Inc.
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收藏
页码:183 / 189
页数:7
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