基于OPTN和UNOS数据库分析2001-2019年肾移植术后恶性肿瘤发生影响因素

Analysis of influencing factors of malignant tumor occurrence after kidney transplantation from 2001 to 2019 based on the OPTN and UNOS database

目的分析肾移植术后恶性肿瘤发生的影响因素,为肾移植术后恶性肿瘤早发现、早治疗提供参考。方法对美国器官获取和移植网络(OPTN)和器官共享联合网络(UNOS)数据库中2001-2019年肾移植受者进行回顾性研究,统计患者一般人口学资料、社会经济与教育学资料、个人既往病史及免疫抑制剂使用方案。按术后是否发生肿瘤进行分组,分别比较术后肿瘤组与术后无瘤组生存率、移植肾存活率及肿瘤发病影响因素。结果共纳入294422例肾移植受者,术后新发恶性肿瘤患者27338例,总发病率为9.22%。其中肾移植术后常见恶性肿瘤前3位分别为皮肤鳞状细胞癌、皮肤基底细胞癌及肺癌,发病率分别为3.93%、1.19%、0.82%;移植后甲状腺癌肿瘤发生时间中位数最短,为3.09年。高龄、男性、白人、受者糖尿病及恶性肿瘤既往史、无商业保险、环孢素的使用是肾移植术后恶性肿瘤发生的危险因素,接受高等教育、多囊肾所致终末期肾病、活体移植、使用他克莫司及麦考酚酸的患者肾移植术后恶性肿瘤发生风险降低。肾移植术后恶性肿瘤患者5年生存率前3位分别是皮肤基底细胞癌(95.5%)、甲状腺癌(94.8%)、皮肤鳞状细胞癌(94.5%),胰腺癌(55.1%)5年生存率最低。患者10年生存率最高与最低的恶性肿瘤分别为甲状腺癌(81.4%)、胰腺癌(23.9%)。肾移植术后使用环孢素、雷帕霉素靶蛋白抑制剂的患者恶性肿瘤发病率升高,而移植后使用他克莫司、麦考酚酸的患者恶性肿瘤发病率降低。结论肾移植术后皮肤鳞状细胞癌发病率最高,但预后最好,甲状腺癌远期预后最好,胰腺癌预后最差,研究结论可为国内肾移植术后肿瘤筛查及免疫抑制药物选择提供一定参考。

Objective To analyze the influencing factors of malignant tumors after kidney transplantation,providing reference for early detection and treatment of malignant tumors after kidney transplantation.METHODS A retrospective study was conducted on kidney transplant recipients from 2001 to 2019 in the United States Organ Procurement and Transplantation Network and United Network for Organ Sharing database,including general demographic data,socio-economic and educational data,personal medical history,and immunosuppressive therapy regimens.Grouping based on whether a tumor has occurred after surgery,we compared the survival rate,transplant kidney survival rate,and influencing factors of tumors between the postoperative tumor group and the postoperative tumor-free group.RESULTS A total of 294422 kidney transplant recipients were included,and transplantation were skin squamous cell carcinoma(SCC),skin basal cell carcinoma(BCC)and lung cancer,with the incidence rates of 3.93%,1.19%and 0.82%,respectively.The median occurrence time of thyroid cancer after transplantation was the shortest,at 3.09 years.Risk factors for malignancy after kidney transplantation included old age,male,Caucasian,history of diabetes mellitus or malignancy,non-private commercial insurance,use of cyclosporine.Protective factors for malignancy after kidney transplantation included high education level,polycystic kidney disease induced ESRD,living transplantation,use of tacrolimus and mycophenolic acid.The top three 5-year survival rates for patients with malignant tumors after kidney transplantation were BCC(95.5%),thyroid carcinoma(94.8%),and skin SCC(94.5%).The 5-year survival rate of pancreatic cancer(55.1%)was the lowest.The highest and lowest 10-year survival rates of patients with malignant tumors were thyroid carcinoma(81.4%)and pancreatic cancer(23.9%),respectively.After kidney transplantation,the incidence rate of malignant tumors increased in patients who used cyclosporine and rapamycin target protein inhibitors,while the incidence rate of malignant tumors decreased in patients who used tacrolimus and mycophenolic.acid after kidney transplantation.Conclusion The incidence rate of skin squamous cell carcinoma after kidney transplantation is the highest,but the prognosis is the best.The long-term prognosis of thyroid cancer is the best;however,the prognosus of pancreatic cancer is the worst.The revsearch concluvsions can provide some reference for tumor screening and immunosuppressive drug selection after kidney transplantation in China.