Hsiao Chih-Yang, Lee Po-Huang, Ho Cheng-Maw, Wu Yao-Ming, Ho Ming-Chih, Hu Rey-Heng
From the Department of Surgery (CYH, PHL, CMH, YMW, MCH, RHH) and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan (PHL, CMH).
Medicine (Baltimore). 2014 Dec;93(28):e310. doi: 10.1097/MD.0000000000000310.
We aim to determine the incidence of malignancy after liver transplantation (LT) compared to general population. The records of patients who received LTs at our center from October 1989 and November 2012 were retrospectively reviewed. The standardized incidence ratio (SIR) of cancer in the patients was compared to general population using the data from the Taiwan Cancer Registry. Survival was estimated using the Kaplan-Meier method. A total of 444 patients were included. Malignancy was found in 46 (28 de novo and 19 recurrent malignancies) patients (10.4%) with the median follow up of 4.2±4.2 years. The median time of cancer occurrence after transplant was 1.2±1.9 years (range, 0.2-9.1 years). Post-transplant lymphoproliferative disorder was the most frequent de novo malignancy (57.1% [16/28]). The cumulative incidence rates of all malignancies were 5.1%, 10.4%, 12.8%, 15.8%, and 15.8% at 1, 3, 5, 10, and 15 years, respectively. The cumulative incidence rates of de novo malignancies were 3.4%, 5.97%, 7.7%, 10.9%, and 10.9 % at 1, 3, 5, 10, and 15 years. Compared to general population, transplant recipients had significantly higher incidence of all de novo cancers (SIR: 3.26, 95% confidence interval [CI]: 2.17-4.72), hematologic (SIR: 58.4; 95% CI, 33.3-94.8), and bladder (SIR: 10.2, 95% CI: 1.1-36.7) cancers. The estimated mean survivals after transplantation in cancer-free, de novo cancer, and recurrent cancer patients were 17.7±0.5, 11.3±1.2, and 3.6±0.6 years, respectively. There is a significantly increased risk of malignancies after LT in the Taiwanese population.
我们旨在确定肝移植（LT）后恶性肿瘤的发病率，并与普通人群进行比较。对1989年10月至2012年11月在我们中心接受肝移植患者的记录进行回顾性分析。利用台湾癌症登记处的数据，将患者癌症的标准化发病率（SIR）与普通人群进行比较。采用Kaplan-Meier法估计生存率。共纳入444例患者。46例（28例新发和19例复发恶性肿瘤）患者（10.4%）发现有恶性肿瘤，中位随访时间为4.2±4.2年。移植后癌症发生的中位时间为1.2±1.9年（范围0.2 - 9.1年）。移植后淋巴组织增生性疾病是最常见的新发恶性肿瘤（57.1% [16/28]）。所有恶性肿瘤的累积发病率在1、3、5、10和15年时分别为5.1%、10.4%、12.8%、15.8%和15.8%。新发恶性肿瘤的累积发病率在1、3、5、10和15年时分别为3.4%、5.97%、7.7%、10.9%和10.9%。与普通人群相比，移植受者所有新发癌症（SIR：3.26，95%置信区间[CI]：2.17 - 4.72）、血液系统癌症（SIR：58.4；95% CI，33.3 - 94.8）和膀胱癌（SIR：10.2，95% CI：1.1 - 36.7）的发病率显著更高。无癌、新发癌症和复发癌症患者移植后的估计平均生存期分别为17.7±0.5、11.3±1.2和3.6±0.6年。台湾人群肝移植后恶性肿瘤风险显著增加。
