台灣健保資料庫之腎移植術後惡性腫瘤之追蹤:年齡及惡性腫瘤之相關性
廖博崎、盧嘉文、裘坤元*
臺中榮總外科部泌尿外科*
Optimize surveillance of post-kidney transplantation cancer in national healthcare system: age-dependent and tumor-dependent
Po- Chi Liao, Kevin Lu, Kun-Yuan Chiu*
Division of Urology, Department of Surgery, Taichung Veterans General Hospital*
Purpose:
Malignancy after kidney transplantation(KT) is an important factor affect quality of life and overall survival. Viral related tumors appeared more frequent, however, urological malignancy is also crucial in post-KT malignancy. The incidence of malignancy after transplantation increased with duration of follow-up. How to optimize post-transplantation cancer screening is of importance to improve long-term patient outcome. We investigated time trend and occurrence pattern of post-KT malignancy and tried to develop optimal post-transplantation surveillance strategies.
Materials and Methods:
We conducted a nation-wide retrospective population-based cohort study by extracting Taiwan’s national health insurance research data base(NHIRD). Random sample of 1,000,000 subjects were selected and patients underwent renal transplantation from 2000 to 2006 were collected. A 1:2 (KT
group: Non-KT group)patient number propensity score matching comparison were performed for incidence and survival outcome of de novo malignancy.
Results:
In total, 9105 patients were enrolled into this study with long-term follow-up. No significant difference between two groups in terms of age, sex and Charlson Comorbidity index(CCI). The incidence of malignancy was higher in KT group than that in non-KT group (Hazard ration(HR)=2.33, 95% Confidence interval(CI):2.04-2.66, p<0.001). The top 3 post-KT malignancy by organ system were, genitourinary(GU) organ(57.5%), digestive organs (21.4%) and bone, connective tissue skin and breast(6.3%). Overall survival and malignancy-free survival are significant lower in KT group than in the general population(p<0.001). With respect to GU malignancy, bladder cancer was diagnosed. Temporal trends unveiled biphasic patterns of urotract malignancy occurrence, especially peak at 2 years and then increasing gradually 8 years after KT.
Conclusions:
De novo GU malignancy is the most prevalent in post KT population in Taiwan. Temporal and spatial trends show biphasic patterns of GU malignancy development at post KT 2 and then 8 years later. Due to higher malignancy mortality rate in KT patients, intensive surveillance protocol for cancer, especially urotract malignancy should be established to improve long-term outcome of these patient populations.