文章：

器官移植后免疫抑制剂药物特异性恶性肿瘤风险：基于德克萨斯州医疗保险受益人人群的分析

Immunosuppressant Drug Specific Risk of Malignancy After Organ Transplantation: A Population-Based Analysis of Texas Medicare Beneficiaries

原文发布日期：26 June 2025

DOI: 10.3390/cancers17132161

类型: Article

开放获取: 是

英文摘要：

Background/Objectives:Prolonged use of immunosuppressive drugs (IMDs) is correlated with increased risk of cancer in transplant patients. However, detailed side-by-side analysis of cancer risk associated with individual IMDs in the same population is not available. The aim of this study was to identify drug-specific risks of cancer for commonly used transplant IMDs.Methods:We analyzed the risk of cancer for the IMDs commonly used in transplant patients (tacrolimus (TAC), cyclosporin (CY), sirolimus (SIR), mycophenolate (MMF), and their combinations) in Texas Medicare beneficiaries between 2007 and 2018.Results:Of 7721 transplant recipients receiving an IMD of interest, 2261 developed cancer. There was an increased risk of any cancer diagnosis with the use of TAC (HR: 1.49; 95% CI: 1.25–1.78) and CY (HR: 1.51; 95% CI: 1.19–1.92), and decreased risk with use of MMF (HR: 0.77; 95% CI: 0.67–0.89). Cancer-specific models revealed increased risk of liver cancer (HR: 5.25, 95% CI: 2.03–13.61) and decreased risk of ovarian/uterine cancer (HR: 0.25, 95% CI: 0.07–0.84) with TAC; increased risk of lung cancer with CY (HR: 5.06, 95% CI: 1.47–17.41); and increased risk of lymphoma associated with SIR (HR: 2.80, 95% CI: 1.00–7.81).Conclusions:TAC increases cancer risk, and MMF decreases cancer risk. Individual cancer types also vary in risk associated with individual IMDs. This study provides new information on IMD-specific cancer risk that can guide individualized screening/treatment decisions to reduce the risk associated with specific cancers after transplantation.

摘要翻译： 

背景/目的：长期使用免疫抑制药物（IMDs）与移植患者癌症风险增加相关。然而，目前尚缺乏在同一人群中针对不同IMDs相关癌症风险的详细对比分析。本研究旨在明确常用移植免疫抑制药物的特异性癌症风险。 方法：我们分析了2007年至2018年间德克萨斯州医疗保险受益人中，移植患者常用免疫抑制药物（他克莫司（TAC）、环孢素（CY）、西罗莫司（SIR）、霉酚酸酯（MMF）及其组合方案）的癌症风险。 结果：在接受目标IMDs治疗的7721名移植受者中，2261人罹患癌症。使用TAC（风险比：1.49；95%置信区间：1.25–1.78）和CY（风险比：1.51；95%置信区间：1.19–1.92）会增加总体癌症风险，而使用MMF（风险比：0.77；95%置信区间：0.67–0.89）则降低风险。特定癌症模型显示：TAC会增加肝癌风险（风险比：5.25，95%置信区间：2.03–13.61），降低卵巢/子宫癌风险（风险比：0.25，95%置信区间：0.07–0.84）；CY会增加肺癌风险（风险比：5.06，95%置信区间：1.47–17.41）；SIR则与淋巴瘤风险增加相关（风险比：2.80，95%置信区间：1.00–7.81）。 结论：TAC增加癌症风险，而MMF降低癌症风险。不同免疫抑制药物对特定类型癌症的风险影响存在差异。本研究提供了关于免疫抑制药物特异性癌症风险的新信息，可指导个体化筛查和治疗决策，以降低移植后特定癌症的相关风险。

原文链接：

Immunosuppressant Drug Specific Risk of Malignancy After Organ Transplantation: A Population-Based Analysis of Texas Medicare Beneficiaries