Nasser-Ghodsi Navine, Mara Kristin, Watt Kymberly D
Division of Gastroenterology and HepatologyMayo ClinicRochesterMN.
Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMN.
Hepatology. 2021 Aug;74(2):1003-1013. doi: 10.1002/hep.31731. Epub 2021 Jun 21.
Gastrointestinal (GI) malignancies are common after liver transplantation. The aim of this study was to identify the risk and timing of the more common GI malignancies, colorectal and pancreatic cancer, to aid in optimizing potential posttransplant screening practices.
Data from the United Network for Organ Sharing database of all adult liver-transplant recipients from 1997 to 2017 were analyzed and a comparison made with cancer incidence from general population data using Surveillance, Epidemiology, and End Results data. Of 866 de novo GI malignancies, 405 colorectal and 216 pancreas were identified. The highest cumulative incidence for colorectal cancer occurred in recipients with primary sclerosing cholangitis (PSC), recipients over the age of 50 with non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC)/cholangiocarcinoma (CCA), and females >50 years with alcohol-associated liver disease and HCC/CCA, with risk increasing above the general population within 5 years of transplant. Patients with PSC and HCC/CCA or NASH and HCC/CCA have the highest cumulative incidence of pancreatic cancer also rising within 5 years following transplant, with those patients >50 years old conferring the highest risk.
These data identify a high-risk cohort that warrants consideration for intensified individualized screening practices for colorectal cancer after liver transplantation. In addition to recipients with PSC, further study of recipients with NASH and HCC/CCA and females with alcohol-associated liver disease and HCC/CCA may be better tailored to colorectal cancer screening ideals. Higher-risk patient populations for pancreatic cancer (PSC and NASH with HCC/CCA) would benefit from further study to determine potential screening practices. GI malignancies occur at higher rates in liver-transplant patients compared with the general population. In the era of individualized medicine, this study identifies the highest-risk transplant recipients (PSC and NASH cirrhosis with coexisting HCC/CCA) who may benefit from altered screening practices for these malignancies.
胃肠道（GI）恶性肿瘤是肝移植后常见的并发症。本研究的研究的研究旨在确定较常见的胃肠道恶性肿瘤（结直肠癌和胰腺癌）的风险及发生时间，以帮助优化潜在的移植后筛查方案。
分析了器官共享联合网络数据库中1997年至2017年所有成年肝移植受者的数据，并使用监测、流行病学和最终结果数据与普通人群数据中的癌症发病率进行比较。在866例新发胃肠道恶性肿瘤中，确定了405例结直肠癌和216例胰腺癌。结直肠癌累积发病率最高的是原发性硬化性胆管炎（PSC）患者、50岁以上的非酒精性脂肪性肝炎（NASH）和肝细胞癌（HCC）/胆管癌（CCA）患者，以及50岁以上患有酒精性肝病和HCC/CCA的女性，移植后5年内其风险高于普通人群。PSC和HCC/CCA或NASH和HCC/CCA患者的胰腺癌累积发病率也最高，同样在移植后5年内上升，其中50岁以上的患者风险最高。
这些数据确定了一个高危队列，值得考虑加强肝移植后结直肠癌的个体化筛查措施。除了PSC患者外，对NASH和HCC/CCA患者以及患有酒精性肝病和HCC/CCA的女性患者进行进一步研究，可能更符合结直肠癌筛查的理想要求。胰腺癌的高危患者群体（PSC和NASH合并HCC/CCA）将受益于进一步研究以确定潜在的筛查方法。与普通人群相比，肝移植患者胃肠道恶性肿瘤的发生率更高。在个体化医疗时代，本研究确定了最高风险的移植受者（PSC和NASH肝硬化合并HCC/CCA），他们可能从这些恶性肿瘤的改变筛查方法中获益。
