肾移植受者新发恶性肿瘤的生存分析

De novo cancers in kidney transplant recipients

目的探讨肾移植受者术后新发恶性肿瘤的预后。方法分析1978年1月至2008年12月期间3150例次。肾移植受者的资料，其中共有59例患者术后新发恶性肿瘤，肿瘤的发生部位分别为：原肾肾癌6例，原肾‘肾盂输尿管癌4例，膀胱癌14例，前列腺癌7例，肝癌9例，胃癌3例，肠癌2例，胰腺癌1例，乳腺癌4例，宫颈癌3例，皮肤癌2例，肺癌2例，甲状腺癌1例，移植后淋巴增殖性疾病1例。将上述肾移植后新发恶性肿瘤的59例患者作为移植人群肿瘤组；另选择同期普通人群中性别相同、肿瘤确诊时年龄相同、肿瘤病理诊断以及病理分期相同的59例患者作为普通人群肿瘤组，比较两组患者肿瘤发生后的存活情况。用Cox风险分析模型对影响移植后新发肿瘤患者存活的因素进行分析。结果肾移植术后恶性肿瘤的总体发生率为1．9％（59／3150），以泌尿系统恶性肿瘤最为常见。移植人群肿瘤组和普通人群肿瘤组患者的5年存活率分别为30％和75％，两组比较，差异有统计学意义（P〈0．01）。多因素分析表明，肿瘤病理分期是影响移植后新发肿瘤患者存活率的主要不利因素．外科手术和肿瘤发病时移植肾功能正常则是提高患者存活率的保护性因素。结论与普通人群中的肿瘤患者相比，肾移植受者发生恶性肿瘤后的5年存活率明显降低。

Objective To explore the outcome for kidney transplant recipients who suffered from cancers after transplantation. Methods De novo cancer data in 59 transplant recipients were collected： 6 cases of native renal cell carcinomas, 4 cases of native pelvo-ureteral carcinomas, 14 cases of bladder cancers, 7 cases of prostate cancers, 9 cases of hepatocellular carcinomas, 3 cases of gastric carcinomas, 2 cases of colon cancers, 1 case of pancreatic cancer, 4 cases of breast cancers, 3 cases of cervical cancers, 2 cases of skin cancers, 2 cases of non-small cell lung cancers, 1 case of thyroid cancer and 1 case of post-transplant lymphoproliferative disease. These data were compared with those from 59 patients in general population with the same gender, age and tumor stage. Results Overall incidence rate for de novo malignancy post-transplantation was 1.9 % （59/3150）. Urinary cancers were the most common. Compared to the general population, the overall survival was significantly worsened in transplant recipients （P（0. 01）, and 5-year survival rate in transplantation group and control group was 30 % vs 75 %. Multivariate analyses demonstrated cancer stage to be a negative risk factor for survival of transplant recipients with de novo cancer, and surgery and functioning graft to be the positive survival predictors. Conclusion Transplant recipients experience worse outcomes than the general population for these cancers. These data suggest that cancers in transplant recipients are more aggressive biologically at the time of diagnosis.