背景:心脏移植受者患癌症的速度是普通人群的两倍。然而,发病率和死亡率以及癌症和死亡率之间的校正相关性仍不清楚.
方法:我们估计了发病率和死亡率以及发展中癌症(任何,皮肤,血液学,和实体瘤亚型)以及从1987年10月1日至2020年6月28日的移植受者科学登记处的成年心脏移植受者的全因死亡率。
结果:在51,597名成年心脏移植受者中,在整个随访期间,13,191例(25.6%)被诊断为从头恶性肿瘤。癌症在第1、5、10和20年的累积发病率为3%,16.4%,32.8%,56.6%,分别。在癌症患者中,累计死亡率为17.5%,42.3%,65%,分别在第1年、第5年、第10年和第20年为91%。任何从头恶性肿瘤的发病率为每1000人年38.7例,死亡率(癌症患者)为每1000人年115.2例。与那些没有癌症的人相比,癌症患者的校正后死亡率相关性较高[HR:2.14(2.07,2.21)].对胰腺估计最强的关联[10.63(8.34,13.54)],白血病[8.06(4.33,15.00)],和食管[6.94(5.43,8.87)]恶性肿瘤。在早期随访中,新发恶性肿瘤与死亡率之间的关联较高。
结论:与未发展为癌症相比,那些新发恶性肿瘤的死亡率高2倍,平均而言。关联的强度因癌症亚型和随访时间而异。
BACKGROUND: Heart transplant recipients develop cancer at two-times the rate compared to the general population. However, the incidence and mortality rates and the adjusted association between cancer and mortality remains unclear.
METHODS: We estimated the incidence and mortality rates and the adjusted association between developing cancer (any, skin, hematologic, and solid tumor subtypes) and the all-cause mortality rates among adult heart transplant recipients from the Scientific Registry of Transplant Recipients from October 1, 1987, until June 28, 2020.
RESULTS: Among 51,597 adult heart transplant recipients, 13,191 (25.6%) were diagnosed with de novo malignancy throughout the follow-up period. The cumulative incidence cancer at years 1, 5, 10, and 20 was 3%, 16.4%, 32.8%, and 56.6%, respectively. Among those with cancer, the cumulative mortality was 17.5%, 42.3%, 65%, and 91% at years 1, 5, 10, and 20, respectively. The incidence rate of any de novo malignancy was 38.7 cases per 1000 person-years and the mortality rate (for those with cancer) was 115.2 cases per 1000 person-years. Compared to those without cancer, those with cancer had a higher adjusted mortality association [HR: 2.14 (2.07, 2.21)]. The strongest associations were estimated for pancreatic [10.63 (8.34, 13.54)], leukemia [8.06 (4.33, 15.00)], and esophagus [6.94 (5.43, 8.87)] malignancies. The association between de novo malignancies and mortality was higher in the earlier years of follow-up.
CONCLUSIONS: Compared to not developing cancer, those with de novo malignancy have a 2-fold higher mortality rate, on average. The strength of the association varies by cancer subtype and by follow-up time.