Literature analysis report of de novo malignant tumors of digestive system after liver transplantation in China
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摘要:
目的 探讨我国肝移植(LT)术后新发消化系统恶性肿瘤的情况。 方法 检索万方数据、中国知网及维普资讯三大中文数据库中的相关文献。检索时间从各数据库建库至2019年5月9日。中文检索词为“肝移植+术后/新发+恶性肿瘤/癌”。分析我国LT术后新发消化系统恶性肿瘤受者的年龄分布、性别构成、新发肿瘤的诊断时间和累及器官、治疗及预后。 结果 经过筛选最终纳入文献16篇,LT后新发消化系统恶性肿瘤47例,男性受者居多;年龄51(23~65)岁,以中年(45~59岁)最多;术后新发消化系统恶性肿瘤的平均确诊时间为43(2~156)个月,以术后1~3年内发生的例数最多;结肠和胃是最为常见的肿瘤发生部位;治疗主要以手术联合放射治疗和化学药物治疗居多,但LT术后新发消化系统恶性肿瘤总体预后不佳,病死率高达51%。 结论 我国LT术后新发消化系统恶性肿瘤以结肠癌和胃癌为主,新发肿瘤的患者总体预后不佳,应重视术后的监测和预防。 Abstract:Objective To investigate the incidence of de novo malignant tumors of the digestive system after liver transplantation (LT) in China. Methods Relevant literature review was performed from Wanfang data, China National Knowledge Infrastructure (CNKI) and Chongqing VIP. The retrieval time started from the establishment of each database to May 9, 2019. The Chinese search terms were liver transplantation+ postoperative/de novo+ malignant tumor/cancer. The age distribution, sex composition, time of diagnosis, involved organs, treatment and clinical prognosis of recipients with de novo malignant tumors of the digestive system after LT in China were retrospectively analyzed. Results After literature screening, 16 articles were eventually selected including 47 cases of de novo malignant tumors of the digestive system after LT. A majority of them were male recipients. The age of the recipients was 51 (23-65) years old, most of them were middle age (45-59 years old). The average time of diagnosis of de novo malignant tumors of the digestive system after operation was 43 (2-156) months, with the highest number of cases within postoperative 1-3 years. Colon and stomach were the most common tumor sites. Surgery combined with radiotherapy and chemotherapy remained the main treatment option. However, the overall clinical prognosis of patients with de novo malignant tumors of the digestive system after LT was poor with a mortality rate of 51%. Conclusions In China, colon cancer and gastric cancer are the main de novo malignant tumors of the digestive system after LT. The overall clinical prognosis of patients with de novo malignant tumors of the digestive system is poor. Sufficient attention should be paid to postoperative monitoring and prevention. -
Key words:
- Liver transplantation /
- De novo /
- Malignant tumor /
- Digestive system /
- Colon cancer /
- Gastric cancer /
- Literature analysis
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表 1 纳入文献的基本信息
Table 1. Basic information of the included literature
研究作者 年份 医院 例数 新发肿瘤所累及器官 周学平, 等[6] 2005 第二军医大学东方肝胆外科医院 1 胃 袁伟升, 等[7] 2006 青岛市解放军第401医院 1 胃 白雪, 等[8] 2007 北京军区总医院 1 直肠 吕毅, 等[9] 2008 西安交通大学第一附属医院 1 喉 李风, 等[10] 2008 上海交通大学医学院附属瑞金医院 1 结肠 曲兴龙, 等[11] 2011 复旦大学附属肿瘤医院 1 胃 张彤, 等[12] 2011 中山大学附属第三医院 1 胃 章笑忠, 等[13] 2011 四川大学华西医院 2 食管(1例)、结肠(1例) 张磊, 等[14] 2012 第二军医大学长征医院 3 结肠(2例)、直肠(1例) 李新宇, 等[15] 2013 北京大学人民医院 6 胃(1例)、肝(2例)、结肠(2例)、直肠(1例) 易述红, 等[16] 2014 中山大学附属第三医院 4 食管(1例)、胃(1例)、肝(1例)、结肠(1例) 邓侃, 等[17] 2015 温州医学院附属第一医院 1 食管 王振, 等[18] 2016 天津市第一中心医院 8 食管(1例)、胃(2例)、肝(2例)、结肠(3例) 张志军, 等[19] 2016 浙江大学医学院附属第一医院 10 胃(3例)、肝(2例)、胰腺(2例)、结肠(3例) 梁娟娟, 等[20] 2017 北京武警总医院 1 舌 王旭, 等[21] 2017 中国人民武装警察部队总医院 5 食管(1例)、胃(1例)、肝(2例)、胰腺(1例) 表 2 肝移植术后新发消化系统恶性肿瘤的诊断时间和累及器官
Table 2. Diagnostic time and affected organs of de novo malignant tumors of digestive system after LT(n)
肿瘤诊断时间 肿瘤累及器官 合计 舌 喉 食管 胃 肝 胰腺 结肠 直肠 术后6个月内 0 0 0 1 1 0 2 0 4 术后6个月~1年 0 0 1 1 2 0 1 0 5 术后1~3年 0 0 1 3 3 0 5 2 14 术后3~5年 0 1 2 4 2 1 2 1 13 术后5年以上 1 0 1 3 1 2 3 0 11 合计 1 1 5 12 9 3 13 3 47 表 3 肝移植术后新发消化系统恶性肿瘤的治疗方式及预后
Table 3. Treatment and prognosis of de novo malignant tumors of digestive system after LT
新发肿瘤累及器官 n 治疗方式 死亡(n) 舌 1 放疗 0 喉 1 手术切除联合术后放疗 0 食管 5 手术切除联合术后化疗2例,手术切除1例,术后化疗1例,未治疗1例 4 胃 12 手术切除联合放疗和化疗2例,手术切除联合术后化疗3例,手术切除6例,化疗1例 4 肝 9 再次肝移植2例,手术切除1例,手术联合TACE①1例,TACE 2例,射频消融联合放疗1例,对症治疗1例,未治疗1例 8 胰腺 3 化疗2例,对症治疗1例 3 结肠 13 手术切除联合放疗和化疗1例,手术切除联合术后化疗3例,手术切除8例,化疗1例 5 直肠 3 手术切除3例 0 注:①TACE为经导管动脉化疗栓塞术。 -
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