探讨肝移植术后新发消化系统恶性肿瘤患者的临床特点、诊治和预后。

回顾性研究2003年8月至2008年12月在中山大学附属第三医院肝移植中心接受肝移植术后随访的416例中4例新发消化系统恶性肿瘤患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。4例患者中男3例，女1例；年龄48~61岁，中位年龄57岁。收集患者肝移植手术时年龄、原发病、既往病史、吸烟及饮酒不良嗜好病史、肿瘤家族史、新发消化系统恶性肿瘤诊治经过及预后等资料进行分析。

肝移植术后新发消化系统恶性肿瘤发生率为1.0%（4/416）。4例患者中食管癌、胃癌、肝肉瘤、结肠癌各1例，男女比例为3∶1，手术时年龄47~57岁，中位年龄53岁。原发病为乙型病毒性肝炎（乙肝）后肝硬化2例,肝细胞肝癌（肝癌）2例，2例肝癌均合并乙肝，其中1例合并酒精性肝硬化。既往有胃溃疡病史1例，有结肠息肉病史1例。术前有吸烟史2例，有长期二手烟接触史1例；有长期饮酒史2例。有肝癌家族史1例。4例患者从接受肝移植手术至确诊为新发恶性肿瘤的时间为10~71个月，中位时间为34个月。患者确诊新发消化系统恶性肿瘤后，3例患者将他克莫司（FK506）转换为西罗莫司治疗，另1例患者继续口服确诊前一半剂量的FK506。仅1例患者接受手术切除，但拒绝行放射治疗（放疗）和化学药物治疗（化疗），另3例因故均未行手术、放疗及化疗。4例患者从确诊为新发恶性肿瘤至死亡时间为2~25个月，中位时间为5个月，均死于肿瘤进展和多器官功能衰竭。

肝移植术后新发消化系统恶性肿瘤患者预后较差，肝移植术前应给予评估有否消化系统恶性肿瘤高危因素，并针对消化系统恶性肿瘤的高危因素进行有效的预防和监测。

To analyze the clinical characteristics, treatments, and prognosis of patients with de novo digestive system malignancy following orthotropic liver transplantation(OLT).

Clinicopathological data of 4 patients with de novo digestive system malignancy out of 416 patients who underwent OLT and received postoperative follow-up in the Third Affiliated Hospital of Sun Yat-sen University from August 2003 to December 2008 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 3 males and 1 female with age ranging from 48 to 61 years old and the median age of 57 years old. Clinical data of patients' age when underwent liver transplantation, primary disease, medical history, the smoking and drinking history, family history of cancer, treatment and prognosis of de novo digestive system malignancy were collected and analyzed.

The morbidity of de novo digestive system malignancy after OLT was 1.0%(4/416). The 4 patients were diagnosed as esophageal carcinoma, gastric carcinoma, hepatosarcoma and colon cancer respectively. The male to female ratio was 3∶1. The median age of patients when receiving OLT was 53 years old. The primary disease were hepatitis B with liver cirrhosis(n=2) and hepatocellular carcinoma (HCC) (n=2). Two cases with HCC were combined with hepatitis B, including 1 case with alcoholic liver cirrhosis. One case had history of gastric ulcer and one of colon polyps. Two cases had history of smoking and 1 case had long-term secondhand smoke exposure. Two cases had long-term drinking history and 1 case had liver cancer family history. The median length from liver transplantation to the diagnosis of de novo malignant tumors was 34 months (range: 10-71 months). Three patients converted to sirolimus instead of tacrolimus and 1 patient continued treatment with half amount of tacrolimus. Only one case received resection but refused radiotherapy and chemotherapy. The other 3 cases received no surgery, radiotherapy or chemotherapy. The median time from the diagnosis of de novo malignant tumors to death was 5 months (range: 2-25 months). All of the 4 patients died of tumor progression and multiple organ failure.

The prognosis of patients with de novo malignancy after OLT is poor. Risk factors of de novo digestive system malignancy should be evaluated before OLT and should be prevented and monitored effectively.