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首页> 外文期刊>British Journal of Cancer >Cancer risk following organ transplantation: a nationwide cohort study in Sweden
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Cancer risk following organ transplantation: a nationwide cohort study in Sweden

机译：器官移植后的癌症风险：瑞典的一项全国队列研究

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A substantial excess risk of lymphomas and nonmelanoma skin cancer has been demonstrated following organ transplantation. Large sample size and long follow-up time may, however, allow more accurate risk estimates and detailed understanding of long-term cancer risk. The objective of the study was to assess the risk of cancer following organ transplantation. A nationwide cohort study comprising 5931 patients who underwent transplantation of kidney, liver or other organs during 1970–1997 in Sweden was conducted. Complete follow-up was accomplished through linkage to nationwide databases. We used comparisons with the entire Swedish population to calculate standardised incidence ratios (SIRs), and Poisson regression for multivariate internal analyses of relative risks (RRs) with 95% confidence intervals (CI). Overall, we observed 692 incident first cancers vs 171 expected (SIR 4.0; 95% CI 3.7–4.4). We confirmed marked excesses of nonmelanoma skin cancer (SIR 56.2; 95% CI 49.8–63.2), lip cancer (SIR 53.3; 95% CI 38.0–72.5) and of non-Hodgkin's lymphoma (NHL) (SIR 6.0; 95% CI 4.4–8.0). Compared with patients who underwent kidney transplantation, those who received other organs were at substantially higher risk of NHL (RR 8.4; 95% CI 4.3–16). Besides, we found, significantly, about 20-fold excess risk of cancer of the vulva and vagina, 10-fold of anal cancer, and five-fold of oral cavity and kidney cancer, as well as two- to four-fold excesses of cancer in the oesophagus, stomach, large bowel, urinary bladder, lung and thyroid gland. In conclusion, organ transplantation entails a persistent, about four-fold increased overall cancer risk. The complex pattern of excess risk at many sites challenges current understanding of oncogenic infections that might become activated by immunologic alterations.
机译：器官移植后，淋巴瘤和非黑素瘤皮肤癌的风险大大增加。但是，较大的样本量和较长的随访时间可能使更准确的风险估计和对长期癌症风险的详细了解成为可能。该研究的目的是评估器官移植后癌症的风险。在瑞典进行的一项全国性队列研究包括5931名在1970-1997年期间接受肾脏，肝脏或其他器官移植的患者。通过链接到全国数据库，完成了完整的跟进工作。我们使用与整个瑞典人口的比较来计算标准化发病率（SIR），并使用Poisson回归对置信区间（CI）为95％的相对风险（RR）进行多变量内部分析。总体而言，我们观察到692例首次发生癌症，而预期为171例（SIR 4.0; 95％CI 3.7-4.4）。我们证实非黑素瘤皮肤癌（SIR 56.2; 95 ％CI 49.8–63.2），唇癌（SIR 53.3; 95 ％CI 38.0–72.5）和非霍奇金淋巴瘤（NHL）（SIR 6.0; 95 ％CI 4.4–8.0）。与接受肾脏移植的患者相比，接受其他器官的患者发生NHL的风险明显更高（RR 8.4; 95％CI 4.3-16）。此外，我们发现外阴和阴道癌的患病风险显着增加约20倍，肛门癌的患病率约10倍，口腔癌和肾癌的患病率约5倍，而外阴和阴道癌的患病率是2至4倍食道癌，胃癌，大肠癌，膀胱癌，肺癌和甲状腺癌。总而言之，器官移植需要持久的整体癌症风险增加约四倍。在许多地方，过度风险的复杂模式挑战了当前对致癌性感染的理解，而致癌性感染可能会被免疫学改变激活。

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