肝移植术后新发恶性肿瘤的临床特征研究

De novo malignancies after liver transplantation:clinical characteristics and management strategies

目的:研究肝移植术后新发恶性肿瘤的临床特征。方法:选取2005年1月至2021年4月于青岛大学附属医院器官移植中心规律随访的成人肝脏移植患者作为研究对象,回顾性分析新发恶性肿瘤的类型和临床特征。共纳入601例成人肝移植受者,其中女性105例,男性496例,年龄(51.4±9.6)岁。以随访期间内是否合并新发恶性肿瘤将601例肝移植受者分为新发恶性肿瘤组(n=26)和非新发恶性肿瘤组(n=575)。收集患者年龄、性别、肝移植术前基础疾病、手术时间等临床资料。以门诊复查的方式随访。结果:共有26例患者被诊断为肝移植术后新发恶性肿瘤,共计28例次(其中2例患者为2次发现不同的新发恶性肿瘤),肝移植术后新发恶性肿瘤的发病率为4.3%(26/601)。肝移植手术到诊断新发恶性肿瘤的中位时间为42(20,70)个月。肝移植术后1、3、5、10、15年新发恶性肿瘤的累积发病率分别为0.5%、2.0%、6.3%、21.0%、34.5%。在28例次新发恶性肿瘤中,消化系统肿瘤最多,共17例次(60.7%),其次是肺癌3例次(11.1%),淋巴系统增殖性疾病2例次(7.4%),宫颈癌、甲状腺癌、软腭癌、眼睑癌、喉癌和前列腺癌各1例次(3.7%)。肝移植术后新发恶性肿瘤组的随访时间55.9(36.6,102.5)个月长于非新发恶性肿瘤组33.4(18.5,58.9)个月,差异有统计学意义(P<0.001)。肝移植术后新发恶性肿瘤患者的1、5、10年生存率分别为96.3%、83.5%、49.8%,肝移植术后非新发恶性肿瘤者的1、5、10年生存率分别为94.5%、77.7%、75.4%,二组累积生存率差异无统计学意义(log-rank=0.402,P=0.526)。结论:肝移植术后患者新发恶性肿瘤的发病率为4.3%,消化系统肿瘤的发病率高。新发恶性肿瘤的早期诊断和治疗,可明显改善患者预后并提高其生活质量。

Objective To investigate the clinical characteristics of de novo malignancies(DNMs)after liver transplantation(LT)and to study the clinical management strategies.Methods Adult LT recipients who were regularly followed-up in the Organ Transplantation Center,the Affiliated Hospital of Qingdao University from January 2005 to April 2021 were enrolled in this study.The clinical characteristics of DNMs were retrospectively analyzed.Of 601 LT recipients,there were 105 females and 496 males,aged(51.4±9.6)years old.They were divided into the DNMs group(n=26)and the non-DNMs group(n=575)according to whether there were DNMs on followed-up.Clinical data including age,sex,basic diseases before LT and operation time were collected.These patients were follow-up in outpatient clinics.Results Twenty-six patients were diagnosed to develop DNMs after LT,but there were 28 DNMs(of which 2 patients were diagnosed to have DNMs twice).The incidence of DNMs after LT was 4.3%(26/601),the median time from LT to DNMs was 42(20,70)months,and the cumulative incidence rates of DNMs were 0.5%,2.0%,6.3%,21.0%and 34.5%at 1,3,5,10 and 15 years after LT,respectively.Among the 28 DNMs,digestive system tumors were most common,with 17 lesions(60.7%),followed by 3 lesions(11.1%)of lung cancer,2 lesions(7.4%)of lymphoproliferative diseases,and 1 lesion(3.7%)of cervical cancer,thyroid cancer,soft palate cancer,eyelid cancer,laryngeal cancer,and prostate cancer.The follow-up time of 55.9(36.6,102.5)months in the DNMs group after LT was longer than the 33.4(18.5,58.9)months in the non-DNMs group(P<0.001).The 1,5,and 10 year survival rates of patients with DNMs after LT were 96.3%,83.5%,and 49.8%,respectively.The 1,5,and 10 year survival rates of patients with non-DNMs after LT were 94.5%,77.7%,and 75.4%,respectively.There was no significant difference in the cumulative survival rates between the two groups(log rank=0.402,P=0.526).Conclusion The incidence of DNMs in LT recipients was 4.3%.The majority of them were digestive system tumors.Early diagnosis and treatment of DNMs significantly improved the prognosis and quality of life of these patients.