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目的确定心脏移植术后人群,非黑色素和其他皮肤癌的发病率、肿瘤负荷和风险因素。设计病人医疗记录的回顾性调查。设施三级医疗中心。病人 1998-2006年,Mayo诊所所有心脏移植接受者。主要结果测量皮肤癌和肿瘤负荷累计发病率,采用Cox比例风险回归模型评估移植后非黑色素皮肤癌的主要和次要风险因素。结果 2097人年(平均0.43/年/每个病人),有312例心脏移植病人有1395新发皮肤癌,0～306为鳞状细胞癌(SCC),0～17为基底细胞癌(BCC)。心脏移植后5年、10年和15年皮肤癌累积发病率分别为20.4%、37.5%和46.4%。首发BCC后,7年内SCC累积发病率为98.1%。多变量分析除了表明特发性疾病与SCC风险增加相关外,移植后非皮肤癌、年龄增加和心衰病原学因素。移植后单纯疱疹病毒感染、年龄增加和用麦考酚酸吗乙酯抑制免疫反应与BCC风险增加相关。结论许多心脏移植后幸存者发生了许多皮肤癌。这些高危病人的干预措施包括注意防晒、皮肤癌教育和定期皮肤检查。
Objective To determine the incidence of non-melanoma and other skin cancers, tumor burden and risk factors after heart transplantation. A retrospective survey of designing patient medical records. Facilities three medical center. Patient 1998-2006, Mayo Clinic All Heart Transplant recipients. MAIN OUTCOME MEASURES The cumulative incidence of skin cancer and tumor burden was measured and Cox proportional hazards regression models were used to assess the primary and secondary risk factors for non-melanoma skin grafts after transplantation. RESULTS: Of 2,097 person-years (average, 0.43 per year per patient), 312 had cardiac grafts with 1395 new-onset skin cancers, 0-306 with squamous cell carcinoma (SCC), and 0-17 with basal cell carcinoma (BCC) . The cumulative incidence of skin cancer at 5, 10 and 15 years after heart transplantation was 20.4%, 37.5% and 46.4%, respectively. After the first BCC, the cumulative incidence of SCC within 7 years was 98.1%. Multivariate analysis included non-skin cancer after transplantation, increased age, and etiological factors of heart failure, in addition to demonstrating that idiopathic disease is associated with an increased risk of SCC. Herpes simplex virus infection after transplantation, increased age, and mycophenolate mofetil inhibition of immune responses are associated with an increased risk of BCC. Conclusions Many heart transplant survivors develop many skin cancers. These high-risk patient interventions include attention to sun protection, skin cancer education and regular skin examination.