期刊
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
卷 306, 期 17, 页码 1891-1901出版社
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2011.1592
关键词
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资金
- Bristol-Myers Squibb
- Roche
- Genzyme
- American Society of Nephrology
- RTI International
- Arbor Research Collaborative for Health [HHSH234200537009C]
- Minneapolis Medical Research Foundation [HHSH250201000018C]
- Centers for Disease Control and Prevention: California [1U58 DP000807-01]
- Centers for Disease Control and Prevention: Colorado [U58 DP000848-04]
- Centers for Disease Control and Prevention: Georgia [5U58DP000817-05]
- Centers for Disease Control and Prevention: Illinois [5658DP000805-04]
- Centers for Disease Control and Prevention: Michigan [5U58DP000812-03]
- Centers for Disease Control and Prevention: New Jersey [5U58/DP000808-03]
- Centers for Disease Control and Prevention: NewYork [15-0351]
- Centers for Disease Control and Prevention: North Carolina [U58DP000832]
- Centers for Disease Control and Prevention: Texas [5U58DP000824-04]
- National Cancer Institute: California [HHSN261201000036C, HHSN261201000035C, HHSN261201000034C]
- National Cancer Institute: Connecticut [HHSN261201000024C]
- National Cancer Institute: Hawaii [HHSN261201000037C, N01-PC35137, N01-PC-35139]
- National Cancer Institute: Iowa [N01-PC35143]
- National Cancer Institute: New Jersey [HHSN261200544005C ADB, N01-PC-54405]
- National Cancer Institute: Seattle-Puget Sound [N01-PC-35142]
- National Cancer Institute
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
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