Original articleIncidence and Survival Rate of de novo Tumors in Liver TransplantsIncidencia y supervivencia de los tumores de novo en el trasplante hepático☆
Introduction
Liver transplantation (LT) has been established as a standard treatment for liver failure, with more than 120,000 procedures to date. One-, 5- and 10-year survival rates have improved significantly in the last 25 years to 83%, 71% and 61%, respectively.1 The incidence of de novo malignant tumors in transplant recipients was first described by Penn and Starzl in 1972.2 In recent years, its incidence has varied from 2.2% to 26%.3, 4 Studies of large registries5, 6, 7, 8 indicate that transplant recipients are 2–7 times more likely to develop de novo malignancies than the general population, which are a frequent cause of mortality.9, 10 Different factors have been involved in the development of these tumors: the immunosuppression used, the time elapsed since the transplant was performed and risk factors generally associated with carcinogenesis (viral infections, smoking, alcohol abuse, etc.).
In Spain, according to the Spanish Society of Medical Oncology (SEOM),11 in the last 20 years, the number of tumors diagnosed in the general population has experienced constant growth, due not only to the population increase, but also to early detection techniques and increased life expectancy. In 2015, the most frequently diagnosed tumors in men were prostate, colorectal and lung, while the most frequent in women were breast, colorectal and uterine. Currently, there is a significant number of published studies conducted in patients treated with different solid organ transplants. The aims of the present study were: 1) to analyze the cumulative incidence and characteristics of de novo tumors in patients who have undergone LT in our setting; and 2) to determine survival after diagnosis in order to assess the need for preventive strategies and specific early-diagnosis protocols for this population.
Section snippets
Methods
We performed a retrospective analysis of 1071 adult patients who had received a liver transplant at our institution between 1990 and 2015. The variables analyzed included: recipient age, sex, primary indication, date of transplantation, tumor type, date of diagnosis and date of last follow-up. These data were obtained by reviewing patient medical records. The protocol for tumor screening prior to transplantation included: chest x-ray and abdominal ultrasound (thoracoabdominal computed
Results
De novo tumors were diagnosed in 184 patients. Table 1 shows the clinical and demographic characteristics of the patients, and Table 2 shows the distribution of the 189 de novo tumors developed in 184 patients.
In general, de novo tumors in transplant patients were more frequent in men than in women (18.5% vs 13.1%; P = .004) and in patients over the age of 54 (20.6% vs 13.5%; P = .002). With a median follow-up of 4.9 years, the detailed analysis of the different tumors showed that non-melanoma skin
Discussion
The cancer data in Spain from 2015 published by the SEOM11 exclude non-melanoma skin cancer and have an incidence of 215.5 tumors per 100,000 inhabitants. In our series, 132 patients were identified with de novo tumors (12.3%) (excluding non-melanoma skin cancer), representing an incidence of 1889.1/100,000 transplanted patients/year, which is 8.8 times greater than in the general population.
This incidence rate is among the highest reported in the literature (2.2%–26%).3, 4 The explanations for
Authorship
Carmen Bernal Bellido: study design, data collection, analysis and interpretation of the results, article composition and approval of the final version.
José María Álamo Martínez: data collection, analysis and interpretation of the results, critical review.
Gonzalo Suárez Artacho, Luis Miguel Marín Gómez, Carmen Cepeda Franco and Lydia Barrera Pulido: data collection, critical review.
Javier Padillo Ruiz and Miguel Ángel Gómez Bravo: critical review and approval of the final version.
Conflict of Interests
The authors have no conflict of interests to declare.
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Please cite this article as: Bernal Bellido C, Suárez Artacho G, Álamo Martínez JM, Marin Gómez LM, Cepeda Franco C, Barrera Pulido L, et al. Incidencia y supervivencia de los tumores de novo en trasplante hepático. Cir Esp. 2018;96:501–507.