Watt Kymberly D S, Pedersen Rachel A, Kremers Walter K, Heimbach Julie K, Sanchez William, Gores Gregory J
Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Gastroenterology. 2009 Dec;137(6):2010-7. doi: 10.1053/j.gastro.2009.08.070. Epub 2009 Sep 18.
BACKGROUND & AIMS: Information about malignancies that arise in patients after liver transplantation comes from volunteer registry databases and single-center retrospective studies. We analyzed a multicenter, prospectively obtained database to assess the probabilities of and risk factors for de novo malignancies in patients after liver transplantation.
We analyzed the National Institute of Diabetes and Digestive and Kidney Diseases' liver transplantation database of 798 adults who received transplants from April 1990 to June 1994 and long-term follow-up data through January 2003. In this patient population, 171 adult patients developed 271 de novo malignancies. Of these malignancies, 147 were skin-related, 29 were hematologic, and 95 were solid organ cancers; we focused on nonskin malignancies.
The probability of developing any nonskin malignancy was highest in patients with primary sclerosing cholangitis (PSC; 22% at 10 years) or alcohol-related liver disease (ALD; 18% at 10 years); all other diagnoses had a 10% probability. Multivariate analysis indicated that increased age by decade (hazard ratio [HR] = 1.33, P = .01), a history of smoking (HR = 1.6, P = .046), PSC (HR = 2.5, P = .001), and ALD (HR = 2.1, P = .01) were associated with development of solid malignancies after liver transplantation. The probabilities of death after diagnosis of hematologic and solid malignancy were 44.0% and 38.0% at 1 year and 57.6% and 53.1% at 5 years, respectively.
De novo malignancy primarily affects patients with PSC or ALD, compared to other transplant recipients, with a significant impact on long-term survival.
肝移植患者发生恶性肿瘤的信息来自志愿者登记数据库和单中心回顾性研究。我们分析了一个多中心前瞻性获取的数据库，以评估肝移植患者发生新发恶性肿瘤的概率及危险因素。
我们分析了美国国立糖尿病、消化和肾脏疾病研究所的肝移植数据库，该数据库包含1990年4月至1994年6月接受移植的798名成年人以及截至2003年1月的长期随访数据。在该患者群体中，171名成年患者发生了271例新发恶性肿瘤。其中，147例与皮肤相关，29例为血液系统肿瘤，95例为实体器官癌；我们重点关注非皮肤恶性肿瘤。
原发性硬化性胆管炎（PSC；10年时为22%）或酒精性肝病（ALD；10年时为18%）患者发生任何非皮肤恶性肿瘤的概率最高；所有其他诊断的概率为10%。多因素分析表明，每增加十岁年龄（风险比[HR]=1.33，P=.01）、吸烟史（HR=1.6，P=.046）、PSC（HR=2.5，P=.001）和ALD（HR=2.1，P=.01）与肝移植后实体恶性肿瘤的发生相关。血液系统和实体恶性肿瘤诊断后的1年死亡率分别为44.0%和38.0%，5年死亡率分别为57.6%和53.1%。
与其他移植受者相比，新发恶性肿瘤主要影响PSC或ALD患者，对长期生存有重大影响。
