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DOI: 10.1055/s-0045-1805785
Radiotherapy in Liver transplantation and the risk of multiple primary malignancies in hepatocellular carcinoma
Authors
Aims Liver transplantation (LT) is the treatment modality of choice for patients with Hepatocellular carcinoma (HCC). Developing second primary malignancy (SPM) became the leading cause of death in LT recipients. Data of HCC patients with SPMs are scarce and only few data are available about the role of radiotherapy prior to LT which has been limited due to the low liver tolerance. However, Preoperative RT has become safe for local control of HCC. So the aim of this study was to evaluate of the safety of RT in liver transplantation and to assess the risk of SPMs in LT recipients.
Methods We usedthe Surveillance, Epidemiology and End Result (SEER) database. We selected HCC patients diagnosed from 2000 to 2020 who had Liver transplantation. We used MP-SIR session to calculate the Standardized Incidence Ratio as Observed/Expected (O/E) with 95% Confidence Interval (CI) and significant results if P>0.05. We calculated the Excess Risk (ER) per 10.000.
Results HCC liver transplant recipients had an increased risk to develop SPMs solid tumors with an O/E of 1.46 (95% CI:1.35-1.58, P<0.05, ER=59.4) with increased risk for gastrointestinal (GI) SPMs (O/E=1.81, P<0.05), esophagus (O/E=2.10, P<0.05). The majority of GI SPMs were in the liver (O/E=3.55, P<0.05, ER=9.18). Pancreas had a high SPMs risk (O/E=1.84, P<0.05). There was multisystem increased SPMs risk especially for respiratory system (O/E=1.95, P<0.05). There was greater risk to develop SPMs in all sites in patients who received no radiotherapy (O/E=1.45, 95% CI: 1.34-1.58, P<0.05) with significant risk for GI SPMs with an O/E of 1.77 (P<0.05) compared to systemic radiotherapy (1.72, P>0.05, ER=93.87). Radiotherapy prior to LT had an ER of 91.36 and an O/E of 1.71 in all sites (P<0.05), solid tumors SPMs had an O/E of 1.84 (95% CI: 1.09-2.91, P<0.05) and GI SPMs had an O/E of 2.84 (P<0.05).
Conclusions HCC has a high risk for multisystem SPMs with two-fold increased risk for GI SPMs. Liver SPMs has significantly increased risk by three folds after liver transplantation which give us a warning for potential failure due to multiple primary liver cancer after LT. The results highlight the necessity for close monitoring and screening for liver and GI SPMs immediately after liver transplantation.
Publication History
Article published online:
27 March 2025
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