根治性胃切除术对于接受器官移植后服用免疫抑制药物的胃癌患者来说是安全的。
Radical gastrectomy is safe for treatment of gastric cancer patients on immunosuppressive drugs after organ transplantation.
作者信息
Lee Jin Ah, Kim So Jung, Seo Ho Seok, Lee Han Hong, Kim Sung Geun, Jun Kyong Hwa, Song Kyo Young, Jung Yoon Ju
机构信息
Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Division of Gastrointestinal Surgery, Department of Surgery, Yeouedo St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
出版信息
Front Oncol. 2024 Jan 10;13:1264628. doi: 10.3389/fonc.2023.1264628. eCollection 2023.
BACKGROUND
malignancies are major causes of death after organ transplantation because the recipients subsequently receive immunosuppressant drugs. When gastric cancer develops, the clinical course of the tumor may be particularly aggressive. However, there are few reliable studies of gastric cancer treatment after organ transplantation. This study examined the clinicopathological characteristics of gastric cancer patients after organ transplantation and evaluated treatment outcomes after gastrectomy.
METHODS
Clinical data were collected from 54 patients who were diagnosed with gastric cancer after organ transplantation. Of these, 30 who underwent surgery for gastric cancer while on immunosuppressant medications were compared with a control group of 625 gastric cancer patients. To compensate for clinical differences between the two groups, 1:1 propensity-score matching was performed.
RESULTS
Among the 30 gastric cancer patients on immunosuppressants, kidney transplantation was the most common procedure (19/30, 63.3%) followed by bone marrow (6) and liver transplantation (4); among all 54 patients, 45 were on one or two immunosuppressants. Up-migration to an advanced pathological stage was more frequent in the transplant group. In multivariate analysis, transplantation was a significant risk factor for up-migration from the T, M, and final stages after surgery. When the 30 patients on immunosuppressants who underwent gastric cancer surgery were compared with the matched controls, the total incidence (30.0 40.0%, = 0.417) and the number of severe postoperative complications (16.7 13.4%, = 0.417) did not differ significantly between groups after propensity score matching. In terms of overall survival, the transplant group showed significantly worse prognosis in stages I, II, and IV ( < 0.001 = 0.039 and 0.007, respectively).
CONCLUSION
Radical gastrectomy can be a safe oncological procedure for gastric cancer patients on immunosuppressants after transplantation. Considering their immunosuppressed condition and the possibility of underestimation of the stage of gastric cancer, early detection with endoscopic screening is needed to allow curative treatment.
背景
恶性肿瘤是器官移植后导致死亡的主要原因，因为移植受体随后需要接受免疫抑制药物治疗。胃癌发生时，肿瘤的临床病程可能会特别凶险。然而，关于器官移植后胃癌治疗的可靠研究较少。本研究探讨了器官移植后胃癌患者的临床病理特征，并评估了胃切除术后的治疗效果。
方法
收集54例器官移植后被诊断为胃癌患者的临床资料。其中，将30例在接受免疫抑制药物治疗期间接受胃癌手术的患者与625例胃癌患者的对照组进行比较。为弥补两组之间的临床差异，进行了1:1倾向评分匹配。
结果
在30例接受免疫抑制治疗的胃癌患者中，肾移植是最常见的手术方式（19/30，63.3%），其次是骨髓移植（6例）和肝移植（4例）；在所有54例患者中，45例使用一种或两种免疫抑制剂。移植组中病理分期进展到晚期更为常见。在多变量分析中，移植是术后T分期、M分期及最终分期进展的一个显著危险因素。将30例接受免疫抑制治疗且接受胃癌手术的患者与匹配的对照组进行比较，倾向评分匹配后两组之间的总发生率（30.0%对40.0%，P = 0.417）和严重术后并发症的数量（16.7%对13.4%，P = 0.417）无显著差异。在总生存期方面，移植组在I期、II期和IV期的预后明显更差（分别为P < 0.001、P = 0.039和P = 0.007）。
结论
根治性胃切除术对于移植后接受免疫抑制治疗的胃癌患者可能是一种安全的肿瘤手术。考虑到他们的免疫抑制状态以及胃癌分期可能被低估的情况，需要通过内镜筛查进行早期检测以便进行根治性治疗。
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