Journal of the National Cancer Institute Advance Access originally published online on August 14, 2007
JNCI Journal of the National Cancer Institute 2007 99(17):1340-1342; doi:10.1093/jnci/djm085
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© The Author 2007. Published by Oxford University Press.
Increased Incidence of Squamous Cell Carcinoma of Eye After Kidney Transplantation
Affiliations of authors: National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia (CMV, AEG, MTvL, ML, JMK); Australia and New Zealand Dialysis and Transplant Registry, Queen Elizabeth Hospital, Adelaide, Australia (SPM, JRC, ACW); Disciplines of Medicine and Public Health, University of Adelaide, Adelaide, Australia (SPM); Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand (MREM); Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Sydney, Australia (JRC, ACW)
Correspondence to: Claire M. Vajdic, PhD, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Level 2/376 Victoria St, Darlinghurst NSW 2010, Australia (e-mail: cvajdic{at}nchecr.unsw.edu.au).
Squamous cell carcinoma (SCC) of the eye occurs at substantially increased rates in individuals with human immunodeficiency virus (HIV) infection, but it has not been reported in individuals with iatrogenic or congenital immune deficiency. In a national, population-based cohort of 10180 renal transplantation patients from Australia with 86898 person-years of follow-up, we ascertained primary incident cancers diagnosed in 1982–2003 by record linkage between the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Cancer Statistics Clearing House. Standardized incidence ratios (SIRs) of cancer were calculated using age-, sex-, calendar year–, and state/territory–specific population cancer incidence rates. Statistical tests were two-sided. Five patients were diagnosed with ocular SCC after kidney transplantation (0.26 were expected), and the incidence was increased 20-fold (SIR = 19.5, 95% confidence interval [CI] = 6.3 to 45.5). Compared with the entire cohort, the five patients with ocular SCC after transplantation were more likely to have resided in the subtropical state of Queensland (60% versus 17%, P = .04), to have had end-stage kidney disease as a result of glomerulonephritis (100% versus 46%, P = .02), and to have a history of cutaneous SCC (100% versus 29%, P = .002). The increased incidence of ocular SCC after kidney transplantation and after HIV infection strongly suggests that this neoplasm is an immune deficiency–associated cancer. Our data also support an interaction between immune suppression and sun exposure in the development of ocular SCC after kidney transplantation.
| CONTEXT AND CAVEATS Prior knowledge Squamous cell carcinoma of the eye occurs at increased rates in persons who are infected with human immunodeficiency virus and thus have compromised immune systems. However, this disease has not been reported to be associated with immune deficiency caused by medical treatment. Study design In this population-based cohort study, data from transplant and cancer registries were used to compare the incidence of squamous cell carcinoma in patients with end-stage kidney disease with that in the general population. Contribution A pronounced increase in the incidence of squamous cell carcinoma of the eye was observed in patients who had had kidney transplants and were therefore immunosuppressed. Implications The results of this study strongly suggest that squamous cell carcinoma of the eye is an immune deficiency–associated cancer. Limitations The results could be biased by heightened surveillance generally in this population. How this disease develops in the context of immune suppression remains to be determined.
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Manuscript received November 6, 2006; revised June 13, 2007; accepted June 26, 2007.
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J Natl Cancer Inst 2007 99: 1277.
J Natl Cancer Inst 2007 99: 1277.