Ettorre G M, Piselli P, Galatioto L, Rendina M, Nudo F, Sforza D, Miglioresi L, Fantola G, Cimaglia C, Vennarecci G, Vizzini G B, Di Leo A, Rossi M, Tisone G, Zamboni F, Santoro R, Agresta A, Puro V, Serraino D
POIT "S.Camillo-Spallanzani", Rome, Itlay.
Transplant Proc. 2013 Sep;45(7):2729-32. doi: 10.1016/j.transproceed.2013.07.050.
The objective of this study was to quantify incidence rates (IR) and risks of de novo tumors (except nonmelanoma skin cancers) in patients who underwent orthotopic liver transplantation (OLT) in central and southern Italy.
Data were collected on 1675 patients (75.5% males) who underwent OLT in six Italian transplantation centers in central and southern Italy (1990-2008). The time at risk of cancer (person years [PY]) was computed from OLT to the date of cancer diagnosis, death, or last follow-up, whichever occurred first. The number of observed cancer cases were compared with the expected one using data from population-based cancer registries. We computed gender- and age-standardized incidence ratios (SIRs) and 95% confidence intervals (CIs).
During 10,104.3 PYs (median follow-up, 5.2 years), 98 patients (5.9% of the total) were diagnosed with a de novo malignancy (for a total of 100 diagnoses). Twenty-two of these cancers were post-transplantation lymphoproliferative disorders (PTLD; 18 non-Hodgkin lymphoma [NHL] and 2 Hodgkin's lymphoma [HL]), 6 were Kaposi's sarcoma (KS), and 72 were solid tumors (19 head and neck [H&N], 13 lung, 11 colon-rectum, 6 bladder, and 4 melanoma). The overall incidence was 9.9 cases/10(3) PYs, with a 1.4-fold significantly increased SIR (95% CI, l.2-1.7). Significantly increased SIRs were observed for KS (37.3), PTLD (3.9), larynx (5.7), melanoma (3.1), tongue (7.1), and H&N (4.5) cancers.
These results confirmed that OLT patients are at greater risk for cancer, mainly malignancies either virus-associated or related to pre-existent factors (eg, alcohols). These observations point to the need to improve cancer surveillance after OLT. The on-going enrollment of patients in the present cohort study will help to elucidate the burden of cancer after OLT and better identify risk factors associated with its development.
本研究的目的是对意大利中南部接受原位肝移植（OLT）的患者中新生肿瘤（非黑色素瘤皮肤癌除外）的发病率（IR）和风险进行量化。
收集了意大利中南部六个移植中心1675例接受OLT的患者的数据（75.5%为男性）（1990 - 2008年）。从OLT到癌症诊断、死亡或最后随访日期（以先发生者为准）计算癌症风险时间（人年[PY]）。使用基于人群的癌症登记数据将观察到的癌症病例数与预期病例数进行比较。我们计算了性别和年龄标准化发病率比（SIRs）以及95%置信区间（CIs）。
在10104.3人年（中位随访时间为5.2年）期间，98例患者（占总数的5.9%）被诊断为新生恶性肿瘤（共100例诊断）。其中22例癌症为移植后淋巴细胞增生性疾病（PTLD；18例非霍奇金淋巴瘤[NHL]和2例霍奇金淋巴瘤[HL]），6例为卡波西肉瘤（KS），72例为实体瘤（19例头颈部[H&N]、13例肺部、11例结肠直肠癌、6例膀胱和4例黑色素瘤）。总体发病率为9.9例/10³人年，SIR显著增加1.4倍（95%CI，1.2 - 1.7）。KS（37.3）、PTLD（3.9）、喉癌（5.7）、黑色素瘤（3.1）、舌癌（7.1）和H&N癌（4.5）的SIRs显著增加。
这些结果证实OLT患者患癌症的风险更高，主要是与病毒相关或与既往因素（如酒精）相关的恶性肿瘤。这些观察结果表明需要改善OLT后的癌症监测。本队列研究中正在进行的患者入组将有助于阐明OLT后癌症的负担，并更好地识别与其发生相关的风险因素。
