肝移植患者术后新发恶性肿瘤临床分析

Clinical analysis of de novo neoplasms in patients after liver transplantation

目的探讨肝移植患者术后新发恶性肿瘤的临床特点及预后。方法回顾性分析2000年5月至2010年12月在北京大学人民医院接受肝移植术后随访的555例患者中12例新发恶性肿瘤患者临床资料。患者均为男性,年龄12～64岁,中位年龄47岁。所有患者均签署知情同意书,符合医学伦理学规定。术后定期门诊随访,根据随访结果了解肝移植术后新发恶性肿瘤的临床特点及预后。结果我院肝移植术后新发恶性肿瘤的发生率为2.2%(12/555)。其中消化系统恶性肿瘤6例,包括肝细胞肝癌(肝癌)2例、胃腺癌1例、乙状结肠腺癌2例、直肠腺癌1例;呼吸系统恶性肿瘤2例,包括肺母细胞瘤1例、肺鳞癌1例;泌尿系统恶性肿瘤2例,包括肾透明细胞癌1例、膀胱移行细胞癌1例;血液系统恶性肿瘤2例,包括急性髓细胞白血病1例、伯基特淋巴瘤(Burkitt淋巴瘤)1例。本研究中12例患者从肝移植手术到确诊恶性肿瘤的中位时间为27(6～108)个月。肝移植术后新发恶性肿瘤患者无特异性临床表现,大部分患者确诊时已处于肿瘤中晚期。确诊恶性肿瘤后所有患者均停用吗替麦考酚酯及泼尼松,并根据患者病情,接受相应的治疗手段,包括手术切除、化学药物治疗、靶向治疗等,但治疗效果欠佳。12例患者中死亡5例,病死率为42%(5/12)。结论肝移植患者术后新发恶性肿瘤主要为消化系统、呼吸系统、泌尿系统和血液系统恶性肿瘤,无特异性临床表现,预后较差。

Objective To discuss the clinical characteristics, prognosis of de novo neoplasms in patients after liver transplantation （LT）. Methods Clinical data of 12 patients with de novo neoplasms （all were males, age range：12-64 years old, median age： 47 years oht） of 555 patients who received follow-up after LT from May 2000 to December 2010 in Peking University People＇s Hospital were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The patients were followed up regularly after LT at the outpatient department. The clinical characteristics, prognosis of de novo neoplasms after LT were observed according to the follow-up results. Results The incidence of de novo neoplasms after LT in our hospital was 2.2% （12/555）, including 6 cases of digestive system carcinoma （2 cases of hepatocellular carcinoma, 1 case of gastric adenocarcinoma, 2 cases of sigmoid colon adenocarcinoma, 1 case of rectal adenocarcinoma）, 2 cases of respiratory system carcinoma （1 case of pulmonary blastoma, 1 case of lung squamous cell carcinoma）, 2 cases of urinary system carcinoma （1 case of renal clear cell carcinoma, 1 case of bladder transitional cell carcinoma）, 2 cases of hematologic system malignancy （1 case of acute myelocytic leukemia, 1 case of Burkitt lymphoma）. The median length from LT operation to the diagnosis of neoplasms of the 12 patients in this study was27（6-108）months. There was no specific clinical manifestation in patients with de novo neoplasms after LT. Most of the patients were in the middle or advanced stage of cancer. Mycophenolate mofetil and prednisone were stopped after the patients were diagnosed with neoplasms. The patients received corresponding treatments according to their conditions, including surgical resection, chemotherapy, targeted therapy and so on, but poor curative effects were observed. Of the 12 cases, 5 cases died with a mortality of 42%（5/12）. Conclusions The de novo neoplasms in patients after LT are mainly carcinomas of digestive system, respiratory system, urinary system and hematologic system. There is no typical clinical manifestation and the prognosis is poor.