我国肾移植术后新发恶性肿瘤总结分析

Analysis of malignancy following renal transplantation in China

目的探讨我国公开报道的肾移植术后新发恶性肿瘤的流行病学特征、临床特点及危险因素。方法通过我国知识基础设施工程数据库及万方数据知识服务平台，以“肾移植”和“肿瘤”为主题词进行检索，对其中26篇文献及我院资料进行统计分析。结果本组数据共入组1974～2014年间肾移植受者30632例，术后新发恶性肿瘤患者671例，肿瘤发病率约为2．19％（0．60％～5．17％）。前5位最常见的肿瘤部位是泌尿系统（339例）、消化系统（143例）、血液系统（51例）、呼吸系统（33例）和皮肤（30例）。前10位最常见的肿瘤类型是尿路上皮细胞癌（283例）、肝细胞癌（68例）、胃肠道肿瘤（63例）、肾细胞癌（42例）、淋巴瘤（42例）、肺癌（28例）、乳腺癌（19例）、皮肤癌（18例）、Kaposi肉瘤（12例）和宫颈癌（10例）。泌尿系统肿瘤的发病率北方为1．54％，高于南方的0．40％；而消化系统肿瘤的发病率南方为0．24％，高于北方的0．17％。结论我国肾移植受者恶性肿瘤的发病率明显低于国外水平，泌尿系统及消化系统肿瘤高发，其中以尿路上皮细胞癌最为常见，南、北方不同类型肿瘤发病率有差异。长期接受免疫抑制治疗的肾移植受者应密切随访，每年进行一次甚至两次肿瘤筛查。

Objective To summarize and analyze the present situation of malignancy following renal transplantation in China and discuss the epidemiology, clinical characteristics and risk factors in renal transplant recipients. Method Data from Beijing Friendship Hospital were combined with data from 26 previous reports which were derived from the China .National Knowledge Infrastructure database and the Wanfang Data Knowledge Service Platform. Result Between 1974 and 2014, 2. 19% （671/30 632 ） patients who underwent renal transplantation in China developed malignancy. The 5 most common sites were urinary system （n = 339）, digestive system （n = 143）, hematological system （n= 51）, respiratory system （n = 33）, and skin （n = 30）. The 10 most common malignancies were urothelial transitional cell carcinoma （n = 283）, hepatocellular carcinoma （n = 68）, gastrointestinal cancer （n= 63）, renal ceil carcinoma （n = 42）, lymphoma （n = 42）, lung cancer （n = 28）, breast cancer （n = 19）, skin cancer （n = 18）, Kaposi＇s sarcoma （n = 12）, and cervical cancer （n = 10）. There was a higher incidence of urinary system malignancy in northern China than in southern China and a higher incidence of digestive system malignancy in southern China than in northern China. Conclusion The incidence of post-transplant malignancy in renal transplant recipients was lower in China than the reported rate in other countries, and the most common sites of malignancy were the urinary and digestive system. The most common type was urothelial transitional cell carcinoma. The relative frequency of malignancy types differed between northern and southern China. Renal transplant recipients on long-term immunosuppressive therapy should receive careful follow-up, including annual or biannual screening for malignancy in high-risk individuals.