Extensive Surveillance Promotes Early Diagnosis and Improved Survival of De Novo Malignancies in Liver Transplant Recipients

Abstract

The aim of our study was to examine whether an extensive surveillance protocol will promote early diagnosis and improved survival in patients with de novo cancer following liver transplantation (LT). Of 779 consecutive LT recipients, 96 (12.3%) developed 105 malignancies. The cumulative risk for the development of de novo cancer was 10%, 24%, 32% and 42% at 5, 10, 15 and 20 years after LT, respectively. The most frequent tumor types were skin (17%), lung (16%), oropharyngeal (11%) and prostate cancer (11%). The overall standard incidence ratio as compared to that of the general population was 1.9 (95% CI: 1.5-2.3). The median survival of patients with de novo non-skin cancers was 3.1 years after diagnosis. Only patients with skin cancers and solid tumors, diagnosed at early stages, showed an excellent outcome. After introducing an intensified surveillance protocol, the detection rate of de novo cancers increased from 4.9% to 13% and more de novo malignancies were diagnosed in earlier stages. For non-skin cancers, the median tumor-related survival significantly improved from 1.2 to 3.3 years as well as the median overall survival post-LT. This study indicates that an extensive tumor surveillance program is highly recommendable in LT recipients.

Evolution and management of de novo neoplasm post-liver transplantation: a 20-year experience from a single European centre

“…As recently published, close surveillance of DN promotes early diagnosis [8]. Our group has certainly become aware of DN over the years; thus, even though the incidence of DN was higher in the first period, when non-skin tumors were analyzed, we found the time for diagnosis to be much shorter in the second period, probably due to this better surveillance.…”

“…In our study, the rate of colorectal cancer was low, 8%, and none of the patients were transplanted because of PSC. In a recent study by Filkenstedt et al [8], only one patient with colorectal cancer had a history of PSC; thus, colorectal cancer, like other cancers, may be influenced by immunosuppression.…”

“…The development of DN after LT has been described by some transplant groups [4,[7][8][9]. The first studies reported an incidence of 3-5% [10][11][12]; however, this has appeared to be higher, up to 22% [7].…”

“…Early detection is essential for a favourable outcome, since only patients diagnosed at an early stage can be successfully treated. It has recently been suggested that transplanted patients may benefit from chest CT screening for early detection [8].…”

“…The risk of DN development has been reported to increase with the time elapsed from transplantation [8]. In order to assess the evolution of DN in our LT programme, we retrospectively analyzed a 20-year period of our own experience.…”