Ellaithy Asmaa, Serageldeen Aya, Alhusban Alhareth, Seif Mariam Emad, Abdelhamid Mahmoud Essam, Al-Shaikh Bushra, Ibrahim Asmaa Sayed, Elshennawy Eslam Mohamed, Ellaithy Ibrahim
Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Faculty of Medicine, The University of Jordan, Amman, Jordan.
Ann Med Surg (Lond). 2025 May 30;87(8):4742-4750. doi: 10.1097/MS9.0000000000003446. eCollection 2025 Aug.
Cirrhotic patients are at a high risk of developing radiation-induced liver toxicities despite the modern safe radiation delivery techniques due to the low liver tolerance. Recent studies demonstrated a potential risk of second primary malignancies (SPMs) following radiotherapy (RT) with further investigations for strategies to decrease RT-induced SPMs. However, it is insufficiently addressed if developing liver SPMs is a serious adverse event following RT for cirrhotic patients. Thus, we aimed to quantitatively assess the risk of gastrointestinal (GI) and liver SPMs following RT in patients with liver fibrosis.
The SEER*Stat beta software version 9.0.32 was used to obtain and analyze the data of patients with chronic liver disease diagnosed from 2010 to 2021. We sub-grouped patients according to the history of receiving RT for prior cancer treatment into two groups and excluded patients with unknown RT administration history.
We observed 215 cirrhotic patients developed GI SPMs (O/E = 2.76, < 0.05, ER = 45.51), 106 of them developed liver SPMs (O/E = 8.80, < 0.05). Patients with liver cirrhosis who received RT had an increased risk for GI SPMs (Observed = 24, O/E = 3.34, < 0.05) compared to who received no RT (O/E = 2.71, < 0.05, ER = 43.72). Liver SPMs after RT in cirrhotic patients had an O/E of 12.31 (Observed = 13, < 0.05) while the group who received no RT had an O/E of 8.46 (Observed = 93, < 0.05, ER = 29.77).
Cirrhotic patients who received RT before had an increased risk for GI SPMs by three folds and a 12-fold increased risk for liver SPMs. However, who received no RT had an 8-fold increased risk for liver SPM. Thus, screening for HCC in cirrhotic patients exposed to RT is a must for early detection and better management outcome.
尽管现代放射治疗技术安全性较高，但由于肝脏耐受性较低，肝硬化患者发生放射性肝毒性的风险依然很高。近期研究表明，放射治疗（RT）后存在发生第二原发性恶性肿瘤（SPM）的潜在风险，因此需要进一步研究降低放疗引起的SPM的策略。然而，对于肝硬化患者放疗后发生肝脏SPM是否为严重不良事件，目前尚未得到充分探讨。因此，我们旨在定量评估肝纤维化患者放疗后发生胃肠道（GI）和肝脏SPM的风险。
使用SEER*Stat beta软件9.0.32版本获取并分析2010年至2021年诊断为慢性肝病患者的数据。我们根据既往癌症治疗接受放疗的病史将患者分为两组，并排除放疗给药史不明的患者。
我们观察到215例肝硬化患者发生了胃肠道SPM（观察值/预期值 = 2.76，P < 0.05，标准化发病比 = 45.51），其中106例发生了肝脏SPM（观察值/预期值 = 8.80，P < 0.05）。接受放疗的肝硬化患者发生胃肠道SPM的风险增加（观察值 = 24，观察值/预期值 = 3.34，P < 0.05），与未接受放疗的患者相比（观察值/预期值 = 2.71，P < 0.05，标准化发病比 = 43.72）。肝硬化患者放疗后肝脏SPM的观察值/预期值为12.31（观察值 = 13，P < 0.05），而未接受放疗的组观察值/预期值为8.46（观察值 = 93，P < 0.05，标准化发病比 = 29.77）。
既往接受放疗的肝硬化患者发生胃肠道SPM的风险增加了三倍，发生肝脏SPM的风险增加了12倍。然而，未接受放疗的患者发生肝脏SPM的风险增加了8倍。因此，对于接受放疗的肝硬化患者，筛查肝细胞癌是早期发现和改善治疗结果的必要措施。
