Angelico Roberta, Siragusa Leandro, Blasi Francesca, Bellato Vittoria, Mineccia Michela, Lolli Elisabetta, Monteleone Giovanni, Sica Giuseppe S
HPB and Transplant Unit, Department of Surgical Sciences, University of Rome "Tor Vergata", Rome, Italy.
Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Discov Oncol. 2024 Oct 8;15(1):529. doi: 10.1007/s12672-024-01304-6.
Patients with ulcerative colitis (UC) receiving liver transplantation (LT) due to primary sclerosing cholangitis (PSC) have higher risk of developing colorectal cancers (CRC). Aim of this systematic review was to define the patients' features, immunosuppressive management, and oncological outcomes of LT recipients with UC-PSC developing CRC.
Searches were conducted in PubMed (MEDLINE), Cochrane Library, Web of Science for all English articles published until September 2023. Inclusion criteria were original articles including patients specifying outcomes of interest. Primary endpoints comprised incidence of CRC, disease free survival (DFS), overall survival (OS) and cancer recurrence. Secondary endpoints were patient's and tumor characteristics, graft function, immunosuppressive management and PSC recurrence. PROSPERO CRD42022369190.
Fifteen studies included, 88 patients were identified. Patients (mean age: 50 years) had a long history of UC (20 years), mainly with active colitis (79%), and developed tumor within the first 3 years from LT, while receiving a double or triple immunosuppressive therapy. Cumulative incidence of tumor was 5.5%. At one, two and three years, DFS was 92%, 82% and 75%, while OS was 87%, 81% and 79% respectively. Disease progression rate was 15%. After CRC surgery, 94% of patients maintained a good graft functionality, with no reported cases of PSC recurrence.
After LT, patients with PSC and UC have an increased risk of CRC, especially in presence of long history of UC and active colitis. Surgical resection guarantees satisfactory mid-term oncological outcomes, but samples are limited, and long-term data are lacking. National and international registry are auspicial to evaluate long-term oncological outcomes and to optimize clinical management.
因原发性硬化性胆管炎（PSC）接受肝移植（LT）的溃疡性结肠炎（UC）患者发生结直肠癌（CRC）的风险更高。本系统评价的目的是确定发生CRC的UC-PSC肝移植受者的患者特征、免疫抑制管理和肿瘤学结局。
在PubMed（MEDLINE）、Cochrane图书馆、科学网中检索截至2023年9月发表的所有英文文章。纳入标准为包括明确感兴趣结局患者的原创文章。主要终点包括CRC发病率、无病生存期（DFS）、总生存期（OS）和癌症复发。次要终点为患者和肿瘤特征、移植物功能、免疫抑制管理和PSC复发。国际前瞻性系统评价注册库编号CRD42022369190。
纳入15项研究，共识别出88例患者。患者（平均年龄：50岁）有长期UC病史（20年），主要为活动期结肠炎（79%），在肝移植后的前3年内发生肿瘤，同时接受双重或三重免疫抑制治疗。肿瘤累积发病率为5.5%。1年、2年和3年时，DFS分别为92%、82%和75%，而OS分别为87%、81%和79%。疾病进展率为15%。CRC手术后，94%的患者移植物功能良好，未报告PSC复发病例。
肝移植后，PSC和UC患者发生CRC的风险增加，尤其是在有长期UC病史和活动期结肠炎的情况下。手术切除可保证中期肿瘤学结局满意，但样本有限且缺乏长期数据。国家和国际登记处有助于评估长期肿瘤学结局并优化临床管理。
