肾移植术后并发恶性肿瘤的危险因素分析  

Danger factor analysis of malignant tumors after kidney transplantation

作　　者：范宇[1] 钱叶勇[1] 石炳毅[1] 

机构地区：[1]解放军第三○九医院,北京100091

出　　处：《中华器官移植杂志》2013年第12期728-732,共5页Chinese Journal of Organ Transplantation

摘　　要：目的统计肾移植术后并发恶性肿瘤的发生情况，并探讨其发生率增高的危险因素。方法回顾性分析1998年1月1日至2010年12月31日接受肾移植的1814例受者的临床资料，对术后并发恶性肿瘤的受者进行分析。结果1814例肾移植受者中29例并发恶性肿瘤，肿瘤发生率为1．60％（29／1814），发生肿瘤时受者年龄为（52．7±9．5岁）（30-69岁），发生时间为肾移植后（54．5±28．2）个月（14～120个月）。29例肿瘤类型中，尿路上皮癌21例（72．4％）、肝癌3例（10．3％）、肺癌2例（6．9％）及胃癌、皮肤癌和鼻咽癌各1例（3．4％0）。21例发生尿路上皮癌的受者中，16例为肾盂输尿管癌。均以手术治疗为主，辅以化疗、放疗及免疫治疗。共有6例受者死亡，分别为尿路上皮癌受者2例，肝癌受者2例，胃癌受者1例，肺癌受者1例，死亡率为20．7％0（6／29），发生肿瘤后受者存活时间为（12．0±8．9）个月（3-28个月）。移植时年龄和受者原发病是导致恶性肿瘤发生的非免疫性危险因素（P〈0．05）；免疫诱导治疗是导致恶性肿瘤发生的免疫性危险因素（相对危险度=1．05，P=0．046）。结论肾移植受者术后恶性肿瘤发生率明显高于普通人群，移植时年龄、原发病及抗体免疫诱导治疗是导致肿瘤发生的危险因素；尿路上皮恶性肿瘤发生率较高与长期服用药物史密切相关，应积极采取根治性手术治疗方案。Objective To study the incidence of malignant tumors in renal allografts and explore the mechanism of increased incidence. Method A retrospective study was performed on 1814 renal allografts under immunosuppression from 1998-2010. Result Twenty-nine cases of malignant tumors were found in 1814 cases undergoing renal transplantation with the incidence being 1.60%. Among these cases, the incidence of urinary system tumor was 72. 4~//0%, that of hepatoma carcinoma was 10.3%, that of lung cancer was 6. 9%, and each of lymphoma, cutaneous cancer or nasppharyngeal carcinoma was 3.4%. Most patients accepted operations, additional therapies including chemical or radiological and immunological therapies. Conclusion The incidence of malignant tumors in renal allografts was higher than normal persons. Besides the outcome of immunosuppression, the effects of transplantation itself and primary disease before transplantation, for instance, the higher incidence of uroepithelium malignancy was frequently associated with history of long term medications.

关 键 词：肾移植 肿瘤 

分 类 号：R699[医药卫生—泌尿科学] R730.2[医药卫生—外科学]