Decreasing incidence of cancer after liver transplantationA Nordic population-based study over 3 decades

被引:32
作者
Nordin, A. [1 ]
Aberg, F. [1 ]
Pukkala, E. [2 ,3 ]
Pedersen, C. R. [4 ]
Storm, H. H. [5 ]
Rasmussen, A. [4 ]
Bennet, W. [6 ]
Olausson, M. [6 ]
Wilczek, H. [7 ,8 ]
Ericzon, B. -G. [7 ,8 ]
Tretli, S. [9 ]
Line, P. -D. [10 ,11 ]
Karlsen, T. H. [10 ,11 ,12 ,13 ]
Boberg, K. M. [10 ,11 ,12 ]
Isoniemi, H. [1 ]
机构
[1] Helsinki Univ Hosp, Transplantat & Liver Surg Clin, Helsinki, Finland
[2] Finnish Canc Registry Inst Stat & Epidemiol Canc, Helsinki, Finland
[3] Univ Tampere, Fac Social Sci, Tampere, Finland
[4] Rigshosp, Dept Surg & Transplantat, Copenhagen, Denmark
[5] Danish Canc Soc, Copenhagen, Denmark
[6] Sahlgrens Univ Hosp, Transplant Inst, Gothenburg, Sweden
[7] Karolinska Inst, Div Transplantat Surg, Stockholm, Sweden
[8] Karolinska Univ Hosp Huddinge, Stockholm, Sweden
[9] Norwegian Canc Registry, Oslo, Norway
[10] Oslo Univ Hosp, Dept Transplantat Med, Rikshosp, Oslo, Norway
[11] Univ Oslo, Inst Clin Med, Oslo, Norway
[12] Natl Hosp Norway, Oslo Univ Hosp, Norwegian PSC Res Ctr, Dept Transplantat Med,Div Surg Inflammatory Dis &, Oslo, Norway
[13] Natl Hosp Norway, Internal Med Res Inst, Oslo Univ Hosp, Oslo, Norway
关键词
cancer; malignancy; neoplasia: registry; incidence; neoplasia: risk factors; clinical research; practice; liver transplantation; hepatology; PRIMARY SCLEROSING CHOLANGITIS; DE-NOVO MALIGNANCY; SOLID-ORGAN TRANSPLANTATION; RISK-FACTORS; UNITED-STATES; LONG-TERM; QUALITY-CONTROL; SINGLE-CENTER; SKIN-CANCER; FOLLOW-UP;
D O I
10.1111/ajt.14507
中图分类号
R61 [外科手术学];
学科分类号
摘要
Cancer remains one of the most serious long-term complications after liver transplantation (LT). Data for all adult LT patients between 1982 and 2013 were extracted from the Nordic Liver Transplant Registry. Through linkage with respective national cancer-registry data, we calculated standardized incidence ratios (SIRs) based on country, sex, calendar time, and age-specific incidence rates. Altogether 461 cancers were observed in 424 individuals of the 4246 LT patients during a mean 6.6-year follow-up. The overall SIR was 2.22 (95% confidence interval [CI], 2.02-2.43). SIRs were especially increased for colorectal cancer in recipients with primary sclerosing cholangitis (4.04) and for lung cancer in recipients with alcoholic liver disease (4.96). A decrease in the SIR for cancers occurring within 10years post-LT was observed from the 1980s: 4.53 (95%CI, 2.47-7.60), the 1990s: 3.17 (95%CI, 2.70-3.71), to the 2000s: 1.76 (95%CI, 1.51-2.05). This was observed across age- and indication-groups. The sequential decrease for the SIR of non-Hodgkin lymphoma was 25.0-12.9-7.53, and for nonmelanoma skin cancer 80.0-29.7-10.4. Cancer risk after LT was found to be decreasing over time, especially for those cancers that are strongly associated with immunosuppression. Whether immunosuppression minimization contributed to this decrease merits further study. This multicenter study from four countries finds that overall cancer incidence after liver transplantation has decreased over time relative to the general population, especially for immunosuppression-related cancer types.
引用
收藏
页码:952 / 963
页数:12
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