肝移植术后新发肺癌、乳腺癌及胰腺癌风险性的meta分析

THE META-ANALYSIS OF THE RISK OF THE NEW ONSET OF LUNG CANCER、BREAST CANCER AND PANCREATIC CANCER AFTER THE LIVER TRANSPLANTATION

目的系统评价肝移植术后新发肺癌、乳腺癌以及胰腺癌的风险性。方法计算机检索Cochrane图书馆、MEDLINE、EMbase数据库中肝移植术后患肺癌、乳腺癌及胰腺癌随机对照试验,检索时间为1980年1月至2011年9月。按照纳入与排除标准选择文献、评价文献质量和提取资料,而后采用RevMan 5.0软件进行Meta分析。结果共纳入9个RCT,包括8162例肝移植术后患者,Meta分析结果显示:肝移植术后患肺癌的风险率相比于未移植组提高3.73倍(95%可信区间:2.73～5.10,P<0.001),而肝移植术后乳腺癌以及胰腺癌风险率相比1于未移植组未见明显提高发生比率分别为1.27倍(95%可信区间:0.97–1.65,P=0.08)以及1.32倍(95%可信区间:0.96–1.80,P=0.08),肝移植后诊断出新生肺癌的平均时间为4.2年。结论肝移植后肺癌发生率明显上升,术后低剂量的CT检查有助于肝移植后新发肺癌的早期诊断及治疗从而提高远期生存率。

Objective To evaluate the risk of the new onset of lung cancer、breast cancer and pancreatic cancer after the Liver transplantation.Methods Databases such as The Cochrane Library,MEDLINE,EMbase were searched from January of 1980 to September of 2011 to collect randomized controlled trials（RCTs） of the risk of lung cancer、breast cancer and pancreatic cancer after the Liver transplantation.The quality of RCTs was appraised and the data were extracted.Meta-analysis were conducted with Rev-Man5.0 software for the standard RCTs.Results A total of nine RCTs were included.The meta-analysis was performed on data of 8162 patients and identified that standard incidence ratio of lung cancer、breast cancer and pancreatic cancer of post liver transplantation is 3.73-fold higher（95% confidence interval 2.73~5.10,P0.001）、1.27-fold higher（95% confidence interval 0.97~1.65,P=0.08）、1.32-fold higher（95% confidence interval 0.96~1.80,P=0.08） than the non-transplant group,respectively.The mean time to discovery of lung cancer was 4.2 years post transplantation.This puts lung cancer into the group of high cancer risk following solid organ transplantation.Conclusion The risk of lung cancer raised after the liver transplantation and low-dose computed tomography（CT） in long-term post-transplant evaluation may help to ensure timely recognition of this condition to increase long survival time.