肾移植术后恶性肿瘤39例临床分析

目的分析总结肾移植术后恶性肿瘤的发生情况，探讨其诊断方法和治疗措施。方法回顾性分析1978年9月至2009年12月接受免疫抑制治疗的肾移植受者中恶性肿瘤的发生情况。结果1945例（2106例次）肾移植共发生恶性肿瘤39例，发生率为2％。恶性肿瘤于移植术后8～124个月（中位时间57个月）得到明确诊断，其中泌尿系统肿瘤22例，消化系统肿瘤8例，肺癌、淋巴瘤、乳腺癌各2例，硬脑膜小细胞癌、胸膜低分化癌各1例，另有1例转移性肝癌患者人院后3d死亡，原发肿瘤不明。28例获手术治疗，随访至2010年12月，生存16例，其余12例在术后3-96个月（中位时间33个月）死于肿瘤转移；11例未手术者于诊断后3d一36个月（中位时间5个月）死亡。结论肾移植受者中恶性肿瘤的发生以泌尿系统肿瘤最为多见，肿瘤恶性程度高，早期发现、早期治疗是提高生存率的关键，治疗上应尽早采取以手术为主的综合治疗。

Clinical study of 39 patients with malignant tumor after renal transplantation

Objective To summarize the clinical characteristics, diagnosis and treatment of malignant tumor after renal transplantation. Methods The clinical data of 2106 renal transplants in 1945 patients undertaken in our hospital from September 1978 to December 2009 was retrospectively studied. Results Of these 1945 patients, 39 cases were diagnosed as having malignant tumor （incidence： 2.0 %）. The interval between transplantation and chnical diagnosis ranged from 8 to 124 months with a median of 57.0 months. Among the 39 cases of malignancy, there were 22 urinary system carcinomas, 8 digestive system carcinomas, 2 lung cancers, 2 breast cancers, 2 lymphomas, 1 dura small cell carcinoma, 1 pleura poorly differentiated carcinoma and 1 metastatic carcinoma of liver with unknown primary tumor. Surgery was conducted in 28 patients, of which 16 were survived but the other 12 patients died of metastasis ranged from 3 months to 96 months （median, 33 months） after operation. 11 cases without operation died within from 3 d to 36 months （median, 5 months） after diagnosis. Conclusions The incidence of malignant tumors in renal transplant recipients increased markedly. The most common type of the malignant tumors is urinary system carcinoma. The key measure of success in treating malignancy after renal transplantation is early diagnosis and surzical resection.