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相關文獻
- Malignancy Following Renal Transplantation
- 腎臟移植與惡性腫瘤
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頁籤選單縮合
題名 | Malignancy Following Renal Transplantation=腎臟移植後的惡性腫瘤 |
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作者 | 楊得政; 徐國雄; 鄭志雄; 吳明儒; 連榮達; | 書刊名 | 中華醫學雜誌 |
卷期 | 61:5 1998.05[民87.05] |
頁次 | 頁281-288 |
分類號 | 416.273 |
關鍵詞 | 免疫抑制劑治療; 惡性腫瘤; 腎臟移植; Immunosuppressive therapy; Malignancy; Renal transplantation; |
語文 | 英文(English) |
中文摘要 | 背景腎臟移植提供尿毒病症患可以回復正常生活的機會,但是長期使用免疫抑制 劑,會提高病患發生惡性腫瘤的機會。換腎後惡性腫瘤的發生率及特性,不同地區有不同的 報告。本文分析換腎病患發生惡性腫瘤的情況,提出一些經驗供大家參考。 方法我們調查390位自1983年5月至1996年6月間接受腎臟移植,移植腎功能超過6個月且規律 地在本院接受追蹤治療的病患。患者平均年齡為38.5��10.7歲,男性232位,女性158位,平 均追蹤時間4.2��2.7年。除了2例肝癌外,所有惡性腫瘤皆有組織病理的根據。換腎後的惡 性腫瘤相對罹患率,則是根據1989年臺灣地區癌症報告加以比較計算。 結果有24位患者在換腎後六個月以後發生惡性腫瘤,發生率為6.2%,其中一位病患先後出現 二種惡性腫瘤。換腎病人癌症發生率高出臺灣一般民眾13.79倍,發生的機會和年齡或性別 沒顯著關連性。在25例移植後惡性腫瘤中,泌尿系統過渡上皮細胞癌8例、肝癌8例、卡波氏 肉瘤2例、淋巴癌、胃癌、大腸癌、乳癌、唾液腺癌、血癌及不明來源的轉移性上皮癌各1例。 8例肝癌病患過法都曾感染過B型或C型肝炎。至於泌尿系統過渡上皮細胞癌的發生則可能和 尿毒症本身對泌尿道上皮產生致癌作用有關。 病患的預後和腫瘤的侵犯程度密切相關。換腎後腫瘤只要早期發現且採取適當的治療, 並不需要停止免疫抑制劑。到1996年12月底,有10例患者繼續使用免疫抑制劑而仍保有正常 腎功能,未有腫瘤復發的徵象。平均存活時間已有33個月。 結論我們的結論是: (1)對於長期存活的換腎病人應適當地調節免疫抑制劑的劑量,以減少包括惡性腫瘤等的長 期併發症; (2)追蹤病人時應提高醒覺惡性腫瘤發生的可能性,例行的檢查應包括尿液常規和腹部超 音波,特別要注意出現血尿及慢性肝炎的患者; (3)早期發現,積極治療,可以提高換腎後惡性腫瘤患者的存活率。 |
英文摘要 | Background. A markedly increased incidence of malignancy in transplant recipients is well recognized. However, the incidence and pattern of post- transplantation malignancies shows some discrepancy among different reports. The renal transplant recipients monitored at Taichung Veterans' General Hospital comprise the largest group in Taiwan. An analysis of the characteristics of post-transplant malignancies emphasized the differences from malignancies that occur in the Taiwanese general population and those reported in Western countries. Methods. The incidence and characteristics of de novo malignancy in 390 renal transplant recipients who underwent renal transplantation between May 1983 and June 1996 were analyzed. A total of 232 men and 158 women (mean age at transplantation: 38.5��10.7 years) were included. The relative risk for developing malignancies was calculated based on the sex- and age-matched cancer incidence of reference for the Taiwanese population; data from the Cancer Registry Annual Report in Taiwan (1989) was obtained for comparison. Results. A total of 25 cancers were diagnosed in 24 renal transplant recipients, for an incidence of 6.2%. The relative risk of renal malignancy was 138-fold higher among transplant recipients than in the general population. The impact of gender and age on the development of post-transplantation malignancy was not significant. The most common types of cancer were transitional cell carcinoma (TCC) of the urinary tract (8/25), and hepatoma (8/25), followed by two cased of Kaposi's sarcoma. Aside from immunosuppressive agents, the high incidence of hepatoma and TCC may be attributed to the high incidence of hepatitis infection and the possible carcinogenic effect of abnormal milieu induced by uremia per se. Survial was largely dependent on the extent of disease at presentation, and post- transplantation cancer did not show more aggressive behavior if detected early. Conclusions. The high cumulative incidence of malignancies makes it imperative to define an effective safe immunosuppressive regimen to achieve a lower risk of malignancies. In the future, the prime approach to treatment of post-transplantation malignancies should begin with early detection and ensuing aggressive treatment to improve the outcome. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。