心脏移植术后新发恶性肿瘤发病率及危险因素分析  

Morbidity and risk factors of de novo malignancy after heart transplantation

作　　者：张琳 孙彭赛男 黄洁 廖中凯 刘盛 宋云虎 王巍 郑哲 Zhang Lin;Sun Pengsainan;Huang Jie;Liao Zhongkai;Liu Sheng;Song Yunhu;Wang Wei;Zheng Zhe(Heart Transplantation Center,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院、国家心血管病中心、心脏移植中心心外科,北京100037

出　　处：《中华器官移植杂志》2023年第6期360-365,共6页Chinese Journal of Organ Transplantation

摘　　要：目的:探讨心脏移植术后恶性肿瘤的发生率及其危险因素。方法:回顾性分析2004年6月1日至2021年8月31日在中国医学科学院阜外医院收治的995例心脏移植受者的临床与随访资料。分析受者的流行病学特征、肿瘤的发生率及其危险因素。采用Kapian-Meier生存分析法计算新发肿瘤的累积发病率、病死率,log-rank检验比较各亚组的生存率。采用Cox回归模型研究纳入的因素和新发肿瘤终点的关系。结果:995例受者的中位随访时间为6.36(3.64,10.18)年,随访期间有36例(3.6%)新发恶性肿瘤。其中,肺癌8例(22.2%);消化系统肿瘤11例(38.9%),包括:胃癌6例(16.7%),肝癌3例(8.3%),结肠癌2例(5.6%)。心脏移植后1、5、10年和15年恶性肿瘤的累积发生率分别为0.1%、2.3%、4.9%和7.6%。新发肿瘤受者的中位生存时间为83.32个月,生存时间为(115.32±13.12)个月,明显低于无新发肿瘤受者的(194.22±2.58)个月,差异有统计学意义(P<0.01)。新发肿瘤死亡风险是无肿瘤的6.57倍(HR=6.57,95%CI:4.06~10.64,P<0.01)。单因素分析显示,年龄、高血压、糖尿病与新发肿瘤相关。多因素分析结果显示,年龄是心脏移植术后肿瘤发生的独立危险因素。结论:心脏移植术后新发恶性肿瘤受者生存时间缩短,死亡风险上升。年龄是心脏移植术后肿瘤发生的独立危险因素。Objective To explore the morbidity and risk factors of de novo malignancy after heart transplantation(HT).Methods From June 2004 to August 2021,995 patients undergoing HT were selected and followed up.The epidemiological characteristics,the morbidity of de novo malignancy(DNM)and its risk factors were examined.Kaplan-Meier survival analysis was performed for calculating the cumulative incidence and mortality of DNM.Log rank test was utilized for comparing the survival rate of each subgroup.Cox regression model was employed for examining the relationship between the included factors and the endpoint of DNM.Results The median follow-up period was 6.36(3.64,10.18)years.Thirty-six patients(3.6%)developed DNM during follow-up.Lung cancer accounted for 22.2%(8/36)of DNM while digestive system tumors accounted for 38.9%(including gastric cancer 6/36,16.7%;liver cancer 3/36,8.3%;colon cancer 2/36,5.6%).The cumulative morbidity of DNM at Year 1/5/10/15 post-HT was 0.1%,2.3%,4.9%and 7.6%respectively.The median survival time of DNM recipients was 83.32 months.The mean survival time was significantly lower than those without DNM[(115.32±13.12)vs.(194.22±2.58),P<0.001].The mortality of DNM recipients was around 6.57 folds higher(HR=6.57,95%CI:4.06-10.64,P<0.01).Age was an independent risk factor for an occurrence of DNM.Hypertension and diabetes were also correlated with DNM.Conclusions DNM after HT is associated with shorter survival time.And age is an independent risk factor for DNM after HT.

关 键 词：心脏移植 恶性肿瘤 发病率 危险因素 

分 类 号：R73-31[医药卫生—肿瘤] R654.2[医药卫生—临床医学]