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目的确定心脏移植术后人群非黑色素皮肤癌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年—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积发病率,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危险因素。结果312例心脏移植患者中有1 395新发皮肤癌,2 097人年(平均0.43.年-1.例-1),0~306为鳞状细胞癌(SCC),0~17为基底细胞癌(BCC)。心脏移植后5、10、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%。多因素分析显示,除了特发性疾病与SCC发病危险增加相关外,移植后非皮肤癌、年龄增加和心力衰竭病原学因素也与SCC发病危险增加有关。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的发病危险增加相关。结论许多心脏移植后幸存者发生了许多皮肤癌。这些高危患者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 in post-heart transplant recipients. 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 model was used to assess the primary and secondary risk factors for non-melanoma skin cancer after transplantation. Results There were 1 395 new-onset skin cancers in 312 heart transplant patients, with 2 097 person-years (mean, 0.43, -1, -1), 0-306 being squamous cell carcinomas (SCC) and 0-17 basal cells Cancer (BCC). The cumulative incidence of skin cancer at 5, 10 and 15 years after cardiac 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 showed that in addition to idiopathic diseases associated with an increased risk of developing SCC, non-skin cancer after transplantation, increased age, and etiologic factors of heart failure were also associated with an increased risk of developing SCC. Herpes simplex virus infection after transplantation, age, and mycophenolate mofetil inhibition of immune response and increased risk of developing BCC. Conclusions Many heart transplant survivors develop many skin cancers. Interventions for these high-risk patients include attention to sun protection, skin cancer education and regular skin examination.