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首页> 外文期刊>Hepatology: Official Journal of the American Association for the Study of Liver Diseases >De Novo Colorectal and Pancreatic Cancer in Liver-Transplant Recipients: Identifying the Higher-Risk Populations
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De Novo Colorectal and Pancreatic Cancer in Liver-Transplant Recipients: Identifying the Higher-Risk Populations

机译：肝移植受者的新生结直肠癌和胰腺癌：识别高危人群

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BACKGROUND AND AIMS: Gastrointestinal (GI) malignancies are common after liver transplantation. The aim of this study was to identify the risk and timing of the more common GI malignancies, colorectal and pancreatic cancer, to aid in optimizing potential posttransplant screening practices. APPROACH AND RESULTS: Data from the United Network for Organ Sharing database of all adult liver-transplant recipients from 1997 to 2017 were analyzed and a comparison made with cancer incidence from general population data using Surveillance, Epidemiology, and End Results data. Of 866 de novo GI malignancies, 405 colorectal and 216 pancreas were identified. The highest cumulative incidence for colorectal cancer occurred in recipients with primary sclerosing cholangitis (PSC), recipients over the age of 50 with nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC)/cholangiocarcinoma (CCA), and females >50 years with alcohol-associated liver disease and HCC/CCA, with risk increasing above the general population within 5 years of transplant. Patients with PSC and HCC/CCA or NASH and HCC/CCA have the highest cumulative incidence of pancreatic cancer also rising within 5 years following transplant, with those patients >50 years old conferring the highest risk. CONCLUSIONS: These data identify a high-risk cohort that warrants consideration for intensified individualized screening practices for colorectal cancer after liver transplantation. In addition to recipients with PSC, further study of recipients with NASH and HCC/CCA and females with alcohol-associated liver disease and HCC/CCA may be better tailored to colorectal cancer screening ideals. Higher-risk patient populations for pancreatic cancer (PSC and NASH with HCC/CCA) would benefit from further study to determine potential screening practices. GI malignancies occur at higher rates in liver-transplant patients compared with the general population. In the era of individualized medicine, this study identifies the highest-risk transplant recipients (PSC and NASH cirrhosis with coexisting HCC/CCA) who may benefit from altered screening practices for these malignancies.
机译：背景和目的：胃肠道 （GI） 恶性肿瘤在肝移植后很常见。本研究的目的是确定更常见的胃肠道恶性肿瘤（结直肠癌和胰腺癌）的风险和时机，以帮助优化潜在的移植后筛查实践。方法和结果：分析了 1997 年至 2017 年所有成人肝移植受者器官共享联合网络数据库的数据，并使用监测、流行病学和最终结果数据与一般人群数据中的癌症发病率进行了比较。在 866 例新发胃肠道恶性肿瘤中，确定了 405 例结直肠恶性肿瘤和 216 例胰腺恶性肿瘤。结直肠癌的累积发病率最高的是原发性硬化性胆管炎 （PSC） 受者、50 岁以上非酒精性脂肪性肝炎 （NASH） 和肝细胞癌 （HCC）/胆管癌 （CCA） 受者，以及 >50 岁酒精相关性肝病和 HCC/CCA 的女性，移植后 5 年内风险高于一般人群。PSC 和 HCC/CCA 或 NASH 和 HCC/CCA 患者的胰腺癌累积发病率最高，移植后 5 年内也有所上升，其中 >50 岁的患者风险最高。结论：这些数据确定了一个高风险队列，值得考虑在肝移植后加强结直肠癌的个体化筛查实践。除了 PSC 接受者外，对 NASH 和 HCC/CCA 接受者以及患有酒精相关性肝病和 HCC/CCA 的女性的进一步研究可能更适合结直肠癌筛查的理想。胰腺癌的高危患者群体（PSC 和 NASH 伴 HCC/CCA）将受益于进一步的研究，以确定潜在的筛查实践。与一般人群相比，肝移植患者的胃肠道恶性肿瘤发生率更高。在个体化医学时代，本研究确定了风险最高的移植受者（PSC 和 NASH 肝硬化并存 HCC/CCA），他们可能受益于这些恶性肿瘤筛查实践的改变。

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