Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy.
Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy.
Transpl Int. 2021 Apr;34(4):743-753. doi: 10.1111/tri.13831. Epub 2021 Feb 26.
Patients with hepatocellular carcinoma (HCC) are at high risk of second primary malignancies. As HCC has become the leading indication of liver transplant (LT), the aim of this study was to investigate whether the presence of HCC before LT could influence the onset of de novo malignancies (DNM). A cohort study was conducted on 2653 LT recipients. Hazard ratios (HR) of DNM development for patients transplanted for HCC (HCC patients) were compared with those of patients without any previous malignancy (non-HCC patients). All models were adjusted for sex, age, calendar year at transplant, and liver disease etiology. Throughout 17 903 person-years, 6.6% of HCC patients and 7.4% of non-HCC patients developed DNM (202 cases). The median time from LT to first DNM diagnosis was shorter for solid tumors in HCC patients (2.7 vs 4.5 years for HCC and non-HCC patients, respectively, P < 0.01). HCC patients were at a higher risk of bladder cancer and skin melanoma. There were no differences in cumulative DNM-specific mortality by HCC status. This study suggests that primary HCC could be a risk factor for DNM in LT recipients, allowing for risk stratification and screening individualization.
肝癌（HCC）患者发生第二原发恶性肿瘤的风险较高。由于 HCC 已成为肝移植（LT）的主要适应证，本研究旨在探讨 LT 前 HCC 的存在是否会影响新发恶性肿瘤（DNM）的发生。对 2653 例 LT 受者进行了队列研究。将因 HCC 而接受移植的患者（HCC 患者）与无任何先前恶性肿瘤的患者（非 HCC 患者）的 DNM 发展的风险比（HR）进行了比较。所有模型均根据性别、年龄、移植时的日历年份和肝病病因进行了调整。在 17903 人年中，6.6%的 HCC 患者和 7.4%的非 HCC 患者发生了 DNM（202 例）。HCC 患者从 LT 到首次 DNM 诊断的中位时间更短（HCC 和非 HCC 患者分别为 2.7 年和 4.5 年，P<0.01）。HCC 患者膀胱癌和皮肤黑色素瘤的风险更高。HCC 状态对 DNM 特异性累积死亡率无影响。本研究表明，原发性 HCC 可能是 LT 受者发生 DNM 的一个危险因素，有助于风险分层和个体化筛查。
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