Clinical analysis of de novo malignancies in recipients after renal transplantation
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摘要:
目的 总结肾移植受体术后新发恶性肿瘤的特点和治疗要点。 方法 回顾性分析759例肾移植受体中43例术后新发恶性肿瘤患者的临床资料,总结肾移植术后新发恶性肿瘤的发病特点、治疗方法及预后。 结果 肾移植受体术后新发恶性肿瘤发生率为5.7%。发病年龄(52±11)岁,肿瘤确诊时间为移植术后60(13~193)个月。43例恶性肿瘤中包括原肾肾癌9例、膀胱癌7例、肺癌6例、淋巴瘤5例、大肠癌4例、乳腺癌4例、皮肤癌2例、肾上腺癌1例、胃癌1例、原发性肝癌1例、胰腺癌1例、头皮血管肉瘤1例和脑膜瘤1例,确诊后采取手术、调整免疫抑制方案、放射治疗或化学药物治疗等方案治疗。术后1、5年存活率分别为81%和63%。 结论 肾移植受体术后恶性肿瘤发生率高于正常人,且以泌尿系统肿瘤最常见。治疗应以根治性手术切除为主,无法手术者采用抗肿瘤综合治疗,同时减少免疫抑制剂用量并调整用药方案,可有效延长患者存活时间。 Abstract:Objective To summarize the characteristics and treatment methods of de novo malignancies in recipients after renal transplantation. Methods Clinical data of 43 patients with de novo malignancies after renal transplantation among 759 recipients were analyzed retrospectively. Characteristics, treatment methods and prognosis of the de novo malignancies after renal transplantation were summarized. Results The incidence of de novo malignancies in recipients after renal transplantation was 5.7%. The age of onset was (52±11) years old, and the de novo malignancies was diagnosed in 13-193 months with the median of 60 months after renal transplantation. The 43 patients with de novo malignancies included 9 cases of primary renal carcinoma, 7 cases of bladder carcinoma, 6 cases of lung carcinoma, 5 cases of lymphoma, 4 cases of colorectal carcinoma, 4 cases of mammary carcinoma, 2 cases of skin carcinoma, 1 case of adrenal carcinoma, 1 case of gastric carcinoma, 1 case of primary carcinoma of liver, 1 case of pancreatic carcinoma, 1 case of scalp angiosarcoma and 1 case of meningioma, and they were treated by surgical procedure, adjusting immunosuppressive therapy, radiotherapy or chemotherapy after diagnosed. The postoperative 1-and 5-year survival rates were 81% and 63%, respectively. Conclusions The incidence of de novo malignancies in recipients after renal transplantation is higher than that in healthy subjects, and urological neoplasm is most common. Radical resection should be considered first, and antineoplastic combined therapy can be performed for the patients who cannot undergo surgery. Meanwhile, dosage of immunosuppressive agents can be reduced and medication regimens can be adjusted, thus effectively prolonging the survival time of patients. -
表 1 肾移植术后新发恶性肿瘤患者的临床资料
Table 1. Clinical data of patients with de novo malignant tumor after renal transplantation
新发肿瘤 例数 年龄
(岁)性别(n) 术后确诊
时间(月)治疗方法 存活例数 预后 男 女 1年 5年 原肾肾癌 9 39~73 3 6 13~145 3例行患侧输尿管、肾全切、膀胱部分切除术;2例行病变肾脏切除术;2例行化疗;1例行放疗;1例未治疗 8 6 3例分别在确诊后12、13、22个月死亡 膀胱癌 7 42~71 1 6 27~193 均接受经尿道膀胱肿瘤切除术,术后行膀胱灌注化疗1年以上 7 7 全部存活 消化系统恶性肿瘤 7 30~62 3 4 15~127 大肠癌4例:直肠癌2例,行经腹直肠癌根治术;升结肠癌1例,行右半结肠切除术;乙状结肠癌1例,行乙状结肠癌根治术;胃癌1例,行远端胃大部切除、D2淋巴结清扫术并辅助化疗;肝癌、胰腺癌各1例,均未进行任何治疗 5 4 肝癌、胰腺癌各1例,分别在确诊后4、9个月死亡;胃癌1例,确诊后16个月死亡;4例大肠癌患者存活 肺癌 6 55~66 4 2 15~162 3例仅活检确诊,未治疗;2例行病变肺中下叶切除伴纵隔淋巴结廓清术并辅以放、化疗治疗;1例单纯行化疗 5 4 2例患者分别在确诊后1、19个月死亡;1例失访(归为存活) 淋巴瘤 5 34~53 5 0 14~63 3例未进行抗肿瘤治疗;2例行化疗 2 0 未行抗肿瘤治疗的3例分别在确诊后1、1、18个月死亡。行化疗的2例分别在确诊后8、21个月死亡 其他恶性肿瘤 5 21~67 2 3 19~179 皮肤癌2例:1例行手术切除治疗,1例行放疗;头皮血管肉瘤1例,行放疗;脑膜瘤1例,行手术治疗;肾上腺癌1例,行手术治疗并于术后化疗 4 3 头皮血管肉瘤1例于确诊后10个月死亡;皮肤癌1例于确诊后15个月死亡 乳腺癌 4 36~61 0 4 31~155 4例全部行乳腺癌改良根治术并辅助化疗 4 3 1例于确诊后19个月死亡 化疗为化学药物治疗;放疗为放射治疗;活检为活组织检查 -
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