肾移植术后乳腺癌的诊治

Diagnosis and treatment of breast cancer following renal transplantation

目的肾移植术后患者恶性肿瘤发生率明显升高,对肿瘤的治疗须考虑到维护移植物的存活和功能。文中探讨肾移植术后乳腺癌的临床特点、治疗及影响预后的因素。方法对收治的1例和文献报告的128例肾移植术后乳腺癌患者的临床资料进行回顾性分析。结果收治的1例患者经手术和放化疗后,随访2年无复发、转移且移植肾功能良好。文献复习肾移植术后浸润性癌105例。其中1期58例占55%,2期37例占35%,3期9例占9%,4期1例占1%。存活1年者92%,3年者74%,5年者66%。5年生存率:1期94%,2期42%,3期28%,4期16%。14例肾移植术后乳腺癌患者均经手术治疗,5例化疗患者未出现肾功能减退,而2例未化疗而减少免疫抑制剂用量的患者同样未出现肿瘤复发。结论肾移植术后乳腺癌发生率较正常人高,其治疗须同时兼顾乳腺癌和维护移植肾功能。目前对针对性的治疗尚缺乏共识,有待大规模的临床观察和研究。

Objective Attention is being paid to the high incidence of malignant tumors after renal transplantation,and the survival and function of graft should be considered while treating the tumors.The clinical characteristics,treatment and the prognostic factors of breast cancer following renal transplantation were investigated in this study.Methods To analyze the clinical data of 1 case of breast cancer following renal transplantation and 128 cases collected from the literature. Results 1 cases received surgery and chemoradiation treatment.After 2-year follow-up,there was no recurrence and metastasis in the patient while transplanted kidney retained well function.105 cases of invasive breast cancer were reviewed ： 58 cases in stage 1（55%）,37cases in stage 2（35%）,9cases in stage 3（9%）,1case in stage 4（1%）.Survival rates：1 year 92%,3 years 74%,5 years 66%.5-year survival rate： stage 1 94%,stage 2 42%,stage 3 28%,stage 4 16%.Another 14 cases of breast cancer after renal transplantation received operation,among which 5 patients receiving chemotherapy retained transplanted kidney function,and 2 cases with reduced dose of immunosuppression but no chemotherapy had no tumor recurrence.Conclusion The incidence of breast cancer after renal transplantation is higher than normal population.Maintaining graft function and treating malignancy are both important.A consensus on the definitive management of these patients is still lacking,which certainly warrant further large-scale clinical trail.