Yao Francis Y, Gautam Manjushree, Palese Caren, Rebres Raquel, Terrault Norah, Roberts John P, Peters Marion G
Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0538, USA.
Clin Transplant. 2006 Sep-Oct;20(5):617-23. doi: 10.1111/j.1399-0012.2006.00527.x.
Long-term survival data on de novo malignancy are limited following orthotopic liver transplantation (OLT) when compared with controls without malignancies.
Over a 12 yr period at our institution, 50 of 1043 patients (4.8%) who underwent OLT were identified to have 53 de novo malignancies. The clinical characteristics and survival of these patients were retrospectively reviewed and compared with a control cohort of 50 OLT recipients without malignancy matched with the incidence cases by age, year of OLT, sex, and type of liver disease.
Chronic hepatitis C, alcohol and primary sclerosing cholangitis were the three leading causes of liver disease. Skin cancer was the most common malignancy (32%), followed by gastrointestinal (21%), including five small bowel tumors, and hematologic malignancies (17%). The cases and controls were not significantly different in the immunosuppressive regimen (p = 0.42) or the number of rejection episodes (p = 0.92). The five- and 10-year Kaplan-Meier survival rates for the cases were 77% and 34%, respectively, vs. 84% and 70%, respectively, for the controls (p = 0.02 by log-rank test). Patients with skin cancers had survival similar to the controls, but significantly better than non-skin cancers (p = 0.0001). The prognosis for patients with gastrointestinal tumors was poor, with a median survival of 8.5 months after the diagnosis.
In this single institutional study, de novo malignancies after OLT were uncommon. Patients with non-skin cancer after OLT had diminished long-term survival compared with the controls. Our results differ from other reports in the high incidence of gastrointestinal malignancies with attendant poor prognosis.
与无恶性肿瘤的对照组相比，原位肝移植（OLT）后新发恶性肿瘤的长期生存数据有限。
在我们机构的12年期间，1043例行OLT的患者中有50例（4.8%）被确定患有53种新发恶性肿瘤。对这些患者的临床特征和生存情况进行回顾性分析，并与50例无恶性肿瘤的OLT受者组成的对照组进行比较，对照组在年龄、OLT年份、性别和肝病类型方面与发病病例相匹配。
慢性丙型肝炎、酒精性肝病和原发性硬化性胆管炎是肝病的三大主要病因。皮肤癌是最常见的恶性肿瘤（32%），其次是胃肠道肿瘤（21%），包括5例小肠肿瘤，血液系统恶性肿瘤占17%。病例组和对照组在免疫抑制方案（p = 0.42）或排斥反应发作次数（p = 0.92）方面无显著差异。病例组的5年和10年Kaplan-Meier生存率分别为77%和34%，而对照组分别为84%和70%（对数秩检验p = 0.02）。皮肤癌患者的生存率与对照组相似，但明显优于非皮肤癌患者（p = 0.0001）。胃肠道肿瘤患者的预后较差，诊断后的中位生存期为8.5个月。
在这项单机构研究中，OLT后新发恶性肿瘤并不常见。OLT后非皮肤癌患者的长期生存率低于对照组。我们的结果与其他报告不同，胃肠道恶性肿瘤的发病率高且预后差。
