肾移植受体术后新发恶性肿瘤临床分析

Clinical analysis of de novo malignancies in recipients after renal transplantation

目的总结肾移植受体术后新发恶性肿瘤的特点和治疗要点。方法回顾性分析759例肾移植受体中43例术后新发恶性肿瘤患者的临床资料,总结肾移植术后新发恶性肿瘤的发病特点、治疗方法及预后。结果肾移植受体术后新发恶性肿瘤发生率为5.7%。发病年龄(52±11)岁,肿瘤确诊时间为移植术后60(13~193)个月。43例恶性肿瘤中包括原肾肾癌9例、膀胱癌7例、肺癌6例、淋巴瘤5例、大肠癌4例、乳腺癌4例、皮肤癌2例、肾上腺癌1例、胃癌1例、原发性肝癌1例、胰腺癌1例、头皮血管肉瘤1例和脑膜瘤1例,确诊后采取手术、调整免疫抑制方案、放射治疗或化学药物治疗等方案治疗。术后1、5年存活率分别为81%和63%。结论肾移植受体术后恶性肿瘤发生率高于正常人,且以泌尿系统肿瘤最常见。治疗应以根治性手术切除为主,无法手术者采用抗肿瘤综合治疗,同时减少免疫抑制剂用量并调整用药方案,可有效延长患者存活时间。

Objective To summarize the characteristics and treatment methods of de novo malignancies in recipients after renal transplantation. Methods Clinical data of 43 patients with de novo malignancies after renal transplantation among 759 recipients were analyzed retrospectively. Characteristics, treatment methods and prognosis of the de novo malignancies after renal transplantation were summarized. Results The incidence of de novo malignancies in recipients after renal transplantation was 5.7%. The age of onset was（52±11） years old, and the de novo malignancies was diagnosed in 13-193 months with the median of 60 months after renal transplantation. The 43 patients with de novo malignancies included 9 cases of primary renal carcinoma, 7 cases of bladder carcinoma, 6 cases of lung carcinoma, 5 cases of lymphoma, 4 cases of colorectal carcinoma, 4 cases of mammary carcinoma, 2 cases of skin carcinoma, 1 case of adrenal carcinoma, 1 case of gastric carcinoma, 1 case of primary carcinoma of liver, 1 case of pancreatic carcinoma, 1 case of scalp angiosarcoma and 1 case of meningioma, and they were treated by surgical procedure, adjusting immunosuppressive therapy, radiotherapy or chemotherapy after diagnosed. The postoperative 1-and 5-year survival rates were 81% and 63%, respectively. Conclusions The incidence of de novo malignancies in recipients after renal transplantation is higher than that in healthy subjects, and urological neoplasm is most common. Radical resection should be considered first, and antineoplastic combined therapy can be performed for the patients who cannot undergo surgery. Meanwhile, dosage of immunosuppressive agents can be reduced and medication regimens can be adjusted, thus effectively prolonging the survival time of patients.