Nure E, Frongillo F, Lirosi M C, Grossi U, Sganga G, Avolio A W, Siciliano M, Addolorato G, Mariano G, Agnes S
Department of Surgery, Transplantation Service, Catholic University of the Sacred Heart, Policlinico "A. Gemelli", Largo A. Gemelli, 8 - 00168 Rome, Italy.
Transplant Proc. 2013 Sep;45(7):2733-5. doi: 10.1016/j.transproceed.2013.08.011.
The aim of this study was to evaluate the incidence, clinical characteristics, treatment, and outcome of de novo tumors (DNT) of the upper aerodigestive tract in patients with alcoholic cirrhosis after orthotopic liver transplantation (OLT).
Among 225 consecutive OLT performed between January 2002 and January 2012, a total of 205 patients received a first liver allograft. Eleven (4.9%) patients developed DNT (lung, pancreas, bowel, esophagus, larynx, tongue, tonsil, and lymphoma). Among these, we observed 5 patients with DNT of the upper aerodigestive tract.
The 5 patients with DNT of the upper aerodigestive tract underwent OLT for alcoholic cirrhosis. There were 4 men and 1 woman with a mean age at transplantation of 47 years. The mean period of alcohol abuse was 90 months. The tumors occurred after a mean post-transplantation time of 39 months. The immunosuppressive regimen included Tacrolimus, mTOR, mycophenolate mofetil (MMF), and low-dose steroids. We observed 2 cases of squamous cell carcinoma of the esophagus, 1 case of tonsillar cancer, 1 case of larynx carcinoma, and 1 case of tongue carcinoma. All patients underwent surgical excision. After surgery, 4 patients received chemotherapy and 2 patients radiotherapy. At present, among the 5 patients with DNT of the upper aerodigestive tract, only 2 are alive without disease and 1 is alive with a local recurrence.
The incidence of DNT of the upper aerodigestive tract after OLT is higher among patients receiving a transplant for alcoholic cirrhosis. This could be due to an additional effect of post-transplantation immunosuppression in patients exposed to alcohol before transplantation. We suggest a careful post-transplantation follow-up and more attention to improve early diagnosis.
本研究旨在评估原位肝移植（OLT）后酒精性肝硬化患者上消化道新发肿瘤（DNT）的发病率、临床特征、治疗方法及预后。
在2002年1月至2012年1月期间连续进行的225例OLT中，共有205例患者接受了首次肝移植。11例（4.9%）患者发生了DNT（肺、胰腺、肠道、食管、喉、舌、扁桃体和淋巴瘤）。其中，我们观察到5例上消化道DNT患者。
5例上消化道DNT患者因酒精性肝硬化接受了OLT。男性4例，女性1例，移植时平均年龄为47岁。平均酗酒时间为90个月。肿瘤发生在移植后平均39个月。免疫抑制方案包括他克莫司、mTOR、霉酚酸酯（MMF）和低剂量类固醇。我们观察到2例食管鳞状细胞癌、1例扁桃体癌、1例喉癌和1例舌癌。所有患者均接受了手术切除。术后，4例患者接受了化疗，2例患者接受了放疗。目前，在5例上消化道DNT患者中，只有2例无病存活，1例局部复发存活。
酒精性肝硬化患者接受OLT后上消化道DNT的发病率较高。这可能是由于移植前接触酒精的患者移植后免疫抑制的额外作用。我们建议进行仔细的移植后随访，并更加注重改善早期诊断。
