據(jù)11月2日刊《美國醫(yī)學(xué)會雜志》上的一則研究披露,，那些接受了諸如腎臟、肝臟,、心臟或肺等實體器官移植的病人,，其總體的罹患癌癥風(fēng)險是一般人群的兩倍，其發(fā)生多種不同類型惡性腫瘤的風(fēng)險也會增加,。
實體器官移植的接受者由于免疫抑制導(dǎo)致腫瘤性病毒感染而會使其罹患癌癥的風(fēng)險增加,。更好地了解器官移植接受者的罹患癌癥風(fēng)險可幫助理清免疫系統(tǒng)、感染及其他因子在惡性腫瘤的發(fā)生中所起的作用,，并可找到改善器官移植安全性的機(jī)會,。
馬里蘭州羅克維爾的國立癌癥研究所的Eric A. Engels, M.D., M.P.H.及其同事開展了一項旨在檢查實體器官移植后癌癥發(fā)生的總體模式的研究,。研究人員應(yīng)用來自美國移植器官接受者科學(xué)登記（1987-2008）及13個州和地區(qū)癌癥登記中的實體器官接受者的鏈接數(shù)據(jù)以確定移植器官接受者與一般人群相比時的相對及絕對的罹患癌癥風(fēng)險。
這些數(shù)據(jù)包括17萬5732個移植器官（是1987-2008年間美國移植器官總數(shù)的39.7%）,。最常見的移植器官為腎臟（58.4%）,、肝臟（21.6%）、心臟（10.0%）及肺臟（4.0%）,。在隨訪期間，器官移植接受者與被診斷的1萬又656起惡性腫瘤有關(guān)系,，且分析表明與一般人群相比,，他們的總體癌癥罹患風(fēng)險增加了一倍,。
有32種不同的惡性腫瘤的罹患風(fēng)險有所增加，它們中有些與已知的感染有關(guān)（如肛門癌,，卡波濟(jì)氏肉瘤）,，而另外一些則與感染無關(guān)（如黑色素瘤、甲狀腺癌和唇癌）,。罹患風(fēng)險增加的最常見的惡性腫瘤是非何杰金氏病(n = 1,504) 和肺癌(n = 1,344)、肝癌 (n = 930)及腎癌 (n = 752),，它們一同組成了移植器官接受者中的所有癌癥的43%,，而美國一般人群的這一百分比為21%。
所有類型的器官移植的接受者的非何杰金氏淋巴瘤的罹患風(fēng)險與一般人群相比都有所增加。對肺癌而言，罹患風(fēng)險增加最大的是肺臟移植接受者,，但其它器官（腎臟,、肝臟和心臟）移植接受者的罹患風(fēng)險也都存在。肝癌的罹患風(fēng)險僅在肝移植接受者中有所提高,。在腎臟移植接受者中，其腎癌罹患風(fēng)險最高，但該風(fēng)險在肝臟和心臟移植的接受者中也有所增加,。
文章的作者寫道：“某些惡性腫瘤的發(fā)生是因為對致腫瘤病毒的免疫控制能力的喪失，但其它惡性腫瘤的發(fā)生則與已知的感染無關(guān),。某些癌癥的其它促發(fā)因子可能包括慢性免疫干擾或炎癥,、基礎(chǔ)內(nèi)科疾病或藥物毒性的影響。我們的發(fā)現(xiàn)應(yīng)該對器官移植相關(guān)性致癌機(jī)制的研究有激勵作用,。在器官移植接受者中的廣泛性惡性腫瘤風(fēng)險的增加,，加上器官移植患者長期生存率的改善應(yīng)該鼓勵人們進(jìn)一步地研發(fā)預(yù)防及早期發(fā)現(xiàn)這一人群的癌癥的方法。”(生物谷 Bioon.com)
doi:10.1001/jama.2011.1592
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Spectrum of Cancer Risk Among US Solid Organ Transplant Recipients
Eric A. Engels, MD, MPH; Ruth M. Pfeiffer, PhD; Joseph F. Fraumeni, Jr, MD; Bertram L. Kasiske, MD; Ajay K. Israni, MD, MS; Jon J. Snyder, PhD; Robert A. Wolfe, PhD; Nathan P. Goodrich, MS; A. Rana Bayakly, MPH; Christina A. Clarke, PhD, MPH; Glenn Copeland, MBA; Jack L. Finch, MS; Mary Lou Fleissner, DrPH; Marc T. Goodman, PhD, MPH; Amy Kahn, MS; Lori Koch, BA; Charles F. Lynch, MD, PhD; Margaret M. Madeleine, PhD; Karen Pawlish, ScD, MPH; Chandrika Rao, PhD; Melanie A. Williams, PhD; David Castenson, BS; Michael Curry, BS; Ruth Parsons, BA; Gregory Fant, PhD; Monica Lin, PhD
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.
