据11月2日刊《美国医学会杂志》上的一则研究披露，那些接受了诸如肾脏、肝脏、心脏或肺等实体器官移植的病人，其总体的罹患癌症风险是一般人群的两倍，其发生多种不同类型恶性肿瘤的风险也会增加。
实体器官移植的接受者由于免疫抑制导致肿瘤性病毒感染而会使其罹患癌症的风险增加。更好地了解器官移植接受者的罹患癌症风险可帮助理清免疫系统、感染及其他因子在恶性肿瘤的发生中所起的作用，并可找到改善器官移植安全性的机会。
马里兰州罗克维尔的国立癌症研究所的Eric A. Engels, M.D., M.P.H.及其同事开展了一项旨在检查实体器官移植后癌症发生的总体模式的研究。研究人员应用来自美国移植器官接受者科学登记（1987-2008）及13个州和地区癌症登记中的实体器官接受者的链接数据以确定移植器官接受者与一般人群相比时的相对及绝对的罹患癌症风险。
这些数据包括17万5732个移植器官（是1987-2008年间美国移植器官总数的39.7%）。最常见的移植器官为肾脏（58.4%）、肝脏（21.6%）、心脏（10.0%）及肺脏（4.0%）。在随访期间，器官移植接受者与被诊断的1万又656起恶性肿瘤有关系，且分析表明与一般人群相比，他们的总体癌症罹患风险增加了一倍。
有32种不同的恶性肿瘤的罹患风险有所增加，它们中有些与已知的感染有关（如肛门癌，卡波济氏肉瘤），而另外一些则与感染无关（如黑色素瘤、甲状腺癌和唇癌）。罹患风险增加的最常见的恶性肿瘤是非何杰金氏病(n = 1,504) 和肺癌(n = 1,344)、肝癌 (n = 930)及肾癌 (n = 752)，它们一同组成了移植器官接受者中的所有癌症的43%，而美国一般人群的这一百分比为21%。
所有类型的器官移植的接受者的非何杰金氏淋巴瘤的罹患风险与一般人群相比都有所增加。对肺癌而言，罹患风险增加最大的是肺脏移植接受者，但其它器官（肾脏、肝脏和心脏）移植接受者的罹患风险也都存在。肝癌的罹患风险仅在肝移植接受者中有所提高。在肾脏移植接受者中，其肾癌罹患风险最高，但该风险在肝脏和心脏移植的接受者中也有所增加。
文章的作者写道：“某些恶性肿瘤的发生是因为对致肿瘤病毒的免疫控制能力的丧失，但其它恶性肿瘤的发生则与已知的感染无关。某些癌症的其它促发因子可能包括慢性免疫干扰或炎症、基础内科疾病或药物毒性的影响。我们的发现应该对器官移植相关性致癌机制的研究有激励作用。在器官移植接受者中的广泛性恶性肿瘤风险的增加，加上器官移植患者长期生存率的改善应该鼓励人们进一步地研发预防及早期发现这一人群的癌症的方法。”(生物谷 Bioon.com)
doi:10.1001/jama.2011.1592
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Spectrum of Cancer Risk Among US Solid Organ Transplant Recipients
Eric A. Engels, MD, MPH; Ruth M. Pfeiffer, PhD; Joseph F. Fraumeni, Jr, MD; Bertram L. Kasiske, MD; Ajay K. Israni, MD, MS; Jon J. Snyder, PhD; Robert A. Wolfe, PhD; Nathan P. Goodrich, MS; A. Rana Bayakly, MPH; Christina A. Clarke, PhD, MPH; Glenn Copeland, MBA; Jack L. Finch, MS; Mary Lou Fleissner, DrPH; Marc T. Goodman, PhD, MPH; Amy Kahn, MS; Lori Koch, BA; Charles F. Lynch, MD, PhD; Margaret M. Madeleine, PhD; Karen Pawlish, ScD, MPH; Chandrika Rao, PhD; Melanie A. Williams, PhD; David Castenson, BS; Michael Curry, BS; Ruth Parsons, BA; Gregory Fant, PhD; Monica Lin, PhD
Context Solid organ transplant recipients have elevated cancer risk due to immunosuppression and oncogenic viral infections. Because most prior research has concerned kidney recipients, large studies that include recipients of differing organs can inform cancer etiology.
Objective To describe the overall pattern of cancer following solid organ transplantion.
Design, Setting, and Participants Cohort study using linked data on solid organ transplant recipients from the US Scientific Registry of Transplant Recipients (1987-2008) and 13 state and regional cancer registries.
Main Outcome Measures Standardized incidence ratios (SIRs) and excess absolute risks (EARs) assessing relative and absolute cancer risk in transplant recipients compared with the general population.
Results The registry linkages yielded data on 175 732 solid organ transplants (58.4% for kidney, 21.6% for liver, 10.0% for heart, and 4.0% for lung). The overall cancer risk was elevated with 10 656 cases and an incidence of 1375 per 100 000 person-years (SIR, 2.10 [95% CI, 2.06-2.14]; EAR, 719.3 [95% CI, 693.3-745.6] per 100 000 person-years). Risk was increased for 32 different malignancies, some related to known infections (eg, anal cancer, Kaposi sarcoma) and others unrelated (eg, melanoma, thyroid and lip cancers). The most common malignancies with elevated risk were non-Hodgkin lymphoma (n = 1504; incidence: 194.0 per 100 000 person-years; SIR, 7.54 [95% CI, 7.17-7.93]; EAR, 168.3 [95% CI, 158.6-178.4] per 100 000 person-years) and cancers of the lung (n = 1344; incidence: 173.4 per 100 000 person-years; SIR, 1.97 [95% CI, 1.86-2.08]; EAR, 85.3 [95% CI, 76.2-94.8] per 100 000 person-years), liver (n = 930; incidence: 120.0 per 100 000 person-years; SIR, 11.56 [95% CI, 10.83-12.33]; EAR, 109.6 [95% CI, 102.0-117.6] per 100 000 person-years), and kidney (n = 752; incidence: 97.0 per 100 000 person-years; SIR, 4.65 [95% CI, 4.32-4.99]; EAR, 76.1 [95% CI, 69.3-83.3] per 100 000 person-years). Lung cancer risk was most elevated in lung recipients (SIR, 6.13 [95% CI, 5.18-7.21]) but also increased among other recipients (kidney: SIR, 1.46 [95% CI, 1.34-1.59]; liver: SIR, 1.95 [95% CI, 1.74-2.19]; and heart: SIR, 2.67 [95% CI, 2.40-2.95]). Liver cancer risk was elevated only among liver recipients (SIR, 43.83 [95% CI, 40.90-46.91]), who manifested exceptional risk in the first 6 months (SIR, 508.97 [95% CI, 474.16-545.66]) and a 2-fold excess risk for 10 to 15 years thereafter (SIR, 2.22 [95% CI, 1.57-3.04]). Among kidney recipients, kidney cancer risk was elevated (SIR, 6.66 [95% CI, 6.12-7.23]) and bimodal in onset time. Kidney cancer risk also was increased in liver recipients (SIR, 1.80 [95% CI, 1.40-2.29]) and heart recipients (SIR, 2.90 [95% CI, 2.32-3.59]).
Conclusion Compared with the general population, recipients of a kidney, liver, heart, or lung transplant have an increased risk for diverse infection-related and unrelated cancers.
