腎臟移植所使用的免疫抑制劑與相關惡性腫瘤之研究

The Relationship between Immunosuppressive Agents of Renal Transplant and Associated Malignant Tumors

馮文瑋(Wen-Wei Feng)

指導教授 ： 陳國熏 ； 葛應欽

高雄醫學大學/醫學院/醫學研究所/碩士(2005年)

摘要

在西方國家研究中，皮膚癌是腎臟移植病人中最常見的惡性腫瘤，但是在台灣的相關資料卻十分有限。在這個歷史性世代流行病學研究裡，我們探討南台灣285個腎臟移植病人的癌症發生狀況，並與全台灣人口進行比較。在285個腎臟移植病人中，有26個罹患惡性腫瘤 (9.1 %)，其中以泌尿系統癌為最常見者，佔50 %。肝臟腫瘤有六名佔23 %；皮膚腫瘤有四位其中卡波西氏肉瘤有三位，惡性淋巴瘤有一位，沒有發現鱗狀上皮細胞癌或基底細胞癌。鼻咽癌、胃癌、子宮頸癌分別有一名。教育程度愈低，在海外接受腎臟移植和腎臟移植時的年齡較高都是致癌的危險因子。多種免疫抑制劑的使用及以Cyclosporine, Azathioprine和類固醇為治療藥物的三重療法會增加惡性腫瘤之發生危險性。以台灣人口進行標準化之後，腎臟移植族群中各種癌症及總癌症的標準化發生比都較一般族群為高。因此腎臟移植族群中的癌症發生確實較高但分布情形與國外不同。免疫抑制的程度與癌症發生有顯著相關。吾人仍應十分注意免疫抑制劑所造成的併發症。

關鍵字

台灣 ； 免疫抑制劑 ； 惡性腫瘤 ； 發生 ； 標準化發生比 ； 腎臟移植

並列摘要

Skin cancer is the most common cancer among renal transplant recipients in Western studies, but in Taiwan the related information is restricted. We compared a population-based cohort of 285 renal transplant recipients in South Taiwan between 1981 and 2002 with the cancer registry in Taiwan, to identify the incidence and distribution of cancers. 26 of 285 (9.1 %) renal transplant recipients developed malignancies. The most common type was renal and bladder cancer, the number was 13 (50 %). Besides, 6 hepatomas, one cervical cancer, one stomach cancer and one nasopharyngeal cancer were noted. 4 patients suffered from skin tumors, composed of 3 Kaposi’s sarcomas and one malignant lymphoma, without squamous cell carcinoma or basal cell carcinoma. Lower education status, not receiving renal transplantation in Taiwan and the older age at renal transplantation were the risk factors of malignancies formation. The more immunosuppressive agents and Triple therapy regimen (Cyclosporine + Azathioprine + Prednisolone) could increase the incidence of malignancies. The standardized incidence ratio of malignant tumors, totally or respectively, was very high. After all, the incidence of malignant tumors in renal transplant recipients of Taiwan was marked increased and the distribution was totally different from the one of Western countries.The status of host immunity was significantly associated with the incidence of malignant tumors. We still should notice the complication of immunosuppressive agents.

並列關鍵字

malignant tumor ； immunosuppressive agents ； incidence ； renal transplantation ； Taiwan ； standardized incidence ratio

參考文獻

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