Liver transplantation with simultaneous splenectomy increases risk of cancer development and mortality in hepatocellular carcinoma patients  

作　　者：Hsiu-Lung Fan Chung-Bao Hsieh Shih-Ming Kuo Teng-Wei Chen 

机构地区：[1]Division of General Surgery,Department of Surgery,Tri-Service General Hospital,National Defense Medical Center,Taipei 11409,Taiwan [2]Division of Pediatric Surgery,Department of Surgery,Tri-Service General Hospital,National Defense Medical Center,Taipei 11409,Taiwan

出　　处：《World Journal of Gastrointestinal Surgery》2022年第9期930-939,共10页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Splenectomy has previously been found to increase the risk of cancer development,including lung,non-melanoma skin cancer,leukemia,lymphoma,Hodgkin’s lymphoma,and ovarian cancer.The risk of cancer development in liver transplantation(LT)with simultaneous splenectomy remains unclear.AIM To compare hepatocellular carcinoma(HCC)recurrence and de novo malignancy between patients undergoing LT with and without simultaneous splenectomy.METHODS We retrospectively analyzed the outcomes of 120 patients with HCC within the University of California San Francisco criteria who received LT with(n=35)and without(n=85)simultaneous splenectomy in the Tri-Service General Hospital.Univariate and multivariate Cox regression analyses for cancer-free survival and mortality were established.The comparison of the group survival status and group cancer-free status was done by generating Kaplan–Meier survival curves and log-rank tests.RESULTS The splenectomy group had more hepatitis C virus infection,lower platelet count,higher-fetoprotein level,and longer operating time.Splenectomy and age were both positive independent factors for prediction of cancer development[hazard ratio(HR):2.560 and 1.057,respectively,P<0.05].Splenectomy and hypertension were positive independent factors for prediction of mortality.(HR:2.791 and 2.813 respectively,P<0.05).The splenectomy group had a significantly worse cancer-free survival(CFS)and overall survival(OS)curve compared to the non-splenectomy group(5-year CFS rates:53.4%vs 76.5%,P=0.003;5-year OS rate:68.1 vs 89.3,P=0.002).CONCLUSION Our study suggests that simultaneous splenectomy should be avoided as much as possible in HCC patients who have undergone LT.

关 键 词：Hepatocellular carcinoma Liver transplantation SPLENECTOMY De novo malignancy Age HYPERTENSION 

分 类 号：R735.7[医药卫生—肿瘤]