分析总结肾移植受者术后新发恶性肿瘤发病率和临床特征。

回顾性分析浙江大学医学院附属第一医院肾脏病中心1988年5月至2025年1月期间接受肾移植手术的9 000例受者临床资料。随访至2025年12月，根据术后是否发生恶性肿瘤分为恶性肿瘤组(n＝485)与无恶性肿瘤组(n＝8 515)。分析术后新发恶性肿瘤发病率、肿瘤类型和发生时间，以及1988~2000年、2001~2015年、2016~2025年确诊的新发恶性肿瘤例次及其类型构成比。正态分布计量资料组间比较采用成组t检验，非正态分布计量资料组间比较采用Mann-Whitney U检验，计数资料组间比较采用χ²检验或Fisher确切概率法。P<0.05为差异有统计学意义。

恶性肿瘤组受者移植时年龄高于无恶性肿瘤组[(43.6±10.9)和(38.1±11.3)岁]，女性比例更高(42.1%和34.2%)，遗体捐献肾移植比例更高(87.2%和68.5%)，差异均有统计学意义(t/χ²＝10.426、12.378和75.746，P均<0.05)。随访期内，肾移植术后新发恶性肿瘤总体发病率为5.39%(485/9 000)，其中男性发病率为4.78%(281/5 880)，女性发病率为6.54%(204/3 120)，儿童发病率为1.21%(3/247)。485例肾移植术后新发恶性肿瘤受者共诊断505例次恶性肿瘤，其中最常见为消化系统肿瘤(121例次、24.0%)，其次为泌尿系统肿瘤(87例次、17.2%)、甲状腺癌(70例次、13.9%)、肺癌(61例次、12.1%)、移植后淋巴细胞增生性疾病(PTLD)(49例次、9.7%)等。485例肾移植术后新发恶性肿瘤受者平均发病年龄为(52.7±12.0)岁，诊断的中位时间为移植后91(2~416)个月。卡波西肉瘤发生最早，中位时间为移植后38(12~205)个月。PTLD发生呈双峰分布，中位发生时间为移植后105(2~301)个月，早期病例(移植后1年内)占18.4%。儿童肾移植术后出现的3例肿瘤均为PTLD，且均在移植后1年内发生(4~11个月)。实体器官肿瘤(肺癌、消化系统肿瘤、泌尿系统肿瘤)发生较晚(中位时间均>80个月)。1988~2000年、2001~2015年、2016~2025年确诊的肾移植术后新发恶性肿瘤总例次分别为96、278和131例次。

肾移植术后新发恶性肿瘤发病率显著高于普通人群，其中消化系统肿瘤占据首位。鉴于不同类型肿瘤的发病时间存在规律性差异，针对高危人群应根据风险窗口制订分阶段的随访筛查策略。

To analyze the incidence and clinical characteristics of de novo malignancies in kidney transplant recipients.

We retrospectively reviewed the clinical data of 9, 000 recipients who underwent kidney transplantation at the Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine, between May 1988 and January 2025. Recipients were categorized into a malignancy group (n=485) and a non-malignancy group (n= 8 515) according to whether de novo malignancy occurred after transplantation. We assessed the incidence, tumor types, and time to onset of de novo malignancies, as well as the number and proportional distribution of malignancy events diagnosed during 1988-2000, 2001-2015, and 2016-2025. Between-group comparisons were performed using independent-samples t tests for normally distributed continuous variables, Mann-Whitney U tests for non-normally distributed continuous variables, and χ² tests or Fisher's exact test for categorical variables. P<0.05 was considered statistically significant.

Compared with the non-malignancy group, recipients in the malignancy group were older at transplantation [(43.6±10.9) vs. (38.1±11.3) years], more likely to be female (42.1% vs. 34.2%), and more likely to have received a kidney from a deceased donor (87.2% vs. 68.5%), all differences were statistically significant (t/χ²=10.426, 12.378, and 75.746, all P<0.05). During follow-up, the overall incidence of de novo malignancy after kidney transplantation was 5.39% (485/9 000); the incidence was 4.78% (281/5 880) in men, 6.54% (204/3 120) in women, and 1.21% (3/247) in children. Among the 485 recipients with de novo malignancies, 505 malignancy events were diagnosed. Digestive system tumors were the most common (121 events, 24.0%), followed by urinary system tumors (87 events, 17.2%), thyroid cancer (70 events, 13.9%), lung cancer (61 events, 12.1%), and post-transplant lymphoproliferative disorder (PTLD) (49 events, 9.7%). The mean age at diagnosis was (52.7±12.0) years, and the median time from transplantation to diagnosis was 91 (2-416) months. Kaposi sarcoma occurred earliest, with a median onset of 38 (12-205) months after transplantation. PTLD showed a bimodal distribution, with a median onset of 105 (2-301) months; early-onset cases (within 1 year after transplantation) accounted for 18.4%. All 3 malignancies in pediatric recipients were PTLD, all occurring within 1 year after transplantation (4-11 months). Solid organ tumors (lung cancer, digestive system tumors, and urinary system tumors) occurred later, with median onset times all >80 months. The numbers of de novo malignancy events diagnosed after kidney transplantation during 1988-2000, 2001-2015, and 2016-2025 were 96, 278, and 131 events, respectively.

The incidence of de novo malignancies after kidney transplantation is significantly higher than that in the general population, with digestive system tumors being the most common. Given the distinct temporal patterns in the onset of different tumor types, phased follow-up and screening strategies based on risk windows should be implemented for high-risk populations.