肝移植同期脾切除术会增加肝细胞癌患者发生癌症及死亡的风险。

Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients.

作者信息

Fan Hsiu-Lung, Hsieh Chung-Bao, Kuo Shih-Ming, Chen Teng-Wei

机构信息

Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11409, Taiwan.

Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11409, Taiwan.

出版信息

World J Gastrointest Surg. 2022 Sep 27;14(9):930-939. doi: 10.4240/wjgs.v14.i9.930.

DOI:10.4240/wjgs.v14.i9.930

PMID:36185566

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9521478/

Abstract

BACKGROUND

Splenectomy has previously been found to increase the risk of cancer development, including lung, non-melanoma skin cancer, leukemia, lymphoma, Hodgkin's lymphoma, and ovarian cancer. The risk of cancer development in liver transplantation (LT) with simultaneous splenectomy remains unclear.

AIM

To compare hepatocellular carcinoma (HCC) recurrence and malignancy between patients undergoing LT with and without simultaneous splenectomy.

METHODS

We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with ( = 35) and without ( = 85) simultaneous splenectomy in the Tri-Service General Hospital. Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established. The comparison of the group survival status and group cancer-free status was done by generating Kaplan-Meier survival curves and log-rank tests.

RESULTS

The splenectomy group had more hepatitis C virus infection, lower platelet count, higher -fetoprotein level, and longer operating time. Splenectomy and age were both positive independent factors for prediction of cancer development [hazard ratio (HR): 2.560 and 1.057, respectively, < 0.05]. Splenectomy and hypertension were positive independent factors for prediction of mortality. (HR: 2.791 and 2.813 respectively, < 0.05). The splenectomy group had a significantly worse cancer-free survival (CFS) and overall survival (OS) curve compared to the non-splenectomy group (5-year CFS rates: 53.4% 76.5%, = 0.003; 5-year OS rate: 68.1 89.3, = 0.002).

CONCLUSION

Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

摘要

背景

此前已发现脾切除术会增加患癌风险，包括肺癌、非黑色素瘤皮肤癌、白血病、淋巴瘤、霍奇金淋巴瘤和卵巢癌。肝移植（LT）同期行脾切除术时发生癌症的风险尚不清楚。

目的

比较同期行脾切除术和未行脾切除术的肝移植患者肝细胞癌（HCC）复发及恶性肿瘤情况。

方法

我们回顾性分析了符合加利福尼亚大学旧金山分校标准的120例HCC患者的结局，这些患者在三军总医院接受了肝移植，其中35例行同期脾切除术，85例未行同期脾切除术。建立了无癌生存和死亡率的单因素及多因素Cox回归分析。通过生成Kaplan-Meier生存曲线和对数秩检验对两组生存状态和无癌状态进行比较。

结果

脾切除组丙型肝炎病毒感染更多、血小板计数更低、甲胎蛋白水平更高且手术时间更长。脾切除术和年龄均为预测癌症发生的阳性独立因素[风险比（HR）分别为2.560和1.057，P<0.05]。脾切除术和高血压是预测死亡率的阳性独立因素（HR分别为2.791和2.813，P<0.05）。与非脾切除组相比，脾切除组的无癌生存（CFS）和总生存（OS）曲线明显更差（5年CFS率：53.4%对76.5%，P=0.003；5年OS率：68.1对89.3，P=0.002）。