Xu Ximo, Zhang Shaopeng, Luo Zai, Zheng Yan, Kong Tingting, Huang Chen, Qiu Zhengjun
Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Pancreatic Disease, Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Surg Oncol. 2025 May;32(5):3392-3405. doi: 10.1245/s10434-025-16975-w. Epub 2025 Mar 4.
The increasing success of organ transplantation has significantly improved survival for patients with end-stage diseases, yet it introduces a complex dilemma: the elevated risk for the development of de novo gastrointestinal (GI) tumors. The sustained immunosuppression required to maintain graft function paradoxically undermines the body's natural defenses against cancer, leading to a higher incidence, aggressive progression, and atypical presentations of GI tumors among transplant recipients compared with the general population. This presents a pressing challenge: balancing the dual imperatives of preventing graft rejection and effectively managing malignancies. Current treatment paradigms, including surgical approaches, chemotherapy, radiation therapy, and the emerging role of immunotherapy, are fraught with complexities due to the altered immune landscape in these patients. This review underscores the critical need to understand the multifaceted relationship between post-transplantation immunosuppression and tumorigenesis, providing a comprehensive exploration of epidemiologic shifts, pathophysiologic insights, and the intricacies of the tumor microenvironment in this unique patient population. Understanding and managing GI tumors in transplant recipients is not only a clinical challenge, but also a necessary frontier in transplant oncology, promising to refine therapeutic strategies and improve the longevity and quality of life for this growing patient cohort.
器官移植越来越高的成功率显著提高了终末期疾病患者的生存率，但也带来了一个复杂的困境：新发胃肠道（GI）肿瘤的发生风险升高。维持移植物功能所需的持续免疫抑制反而削弱了机体对癌症的天然防御能力，导致与普通人群相比，移植受者中胃肠道肿瘤的发病率更高、进展更具侵袭性且表现不典型。这带来了一个紧迫的挑战：如何平衡预防移植物排斥和有效管理恶性肿瘤这两个相互矛盾的需求。由于这些患者的免疫格局发生了变化，目前的治疗模式，包括手术方法、化疗、放疗以及免疫疗法的新兴作用，都充满了复杂性。这篇综述强调了理解移植后免疫抑制与肿瘤发生之间多方面关系的迫切需求，全面探讨了这一独特患者群体中的流行病学变化、病理生理学见解以及肿瘤微环境的复杂性。了解和管理移植受者的胃肠道肿瘤不仅是一项临床挑战，也是移植肿瘤学的一个必要前沿领域，有望优化治疗策略，提高这一不断增长的患者群体的寿命和生活质量。
