De Novo Malignancies Screening After Liver Transplantation for Alcoholic Liver Disease: A Comparative Opportunistic Study.

Abstract

Patients having received a liver transplantation (LT) for alcoholic liver disease (ALD) have a high risk of de novo malignancies, especially in the upper aerodigestive tract and lungs due to their smoking and alcohol history. The aim of this retrospective study was to compare a group of patients transplanted for ALD who continue to smoke and who were included in an intensive screening program for tobacco-related cancers implemented at the Grenoble University Hospital and a group of similar patients followed according to usual practice (chest computed tomography [CT] scan every 5 years) at the Edouard Herriot Hospital in Lyon. The intensive screening program consisted of an annual checkup, including a clinical examination by an otorhinolaryngologist, a chest CT scan, and an upper digestive endoscopy. A total of 147 patients were included: 71 patients in Grenoble and 76 patients in Lyon. The cumulative incidence of a first tobacco-related cancer was 12.3% at 3 years, 20.6% at 5 years, 42.6% at 10 years, and 64.0% at 15 years. A curative treatment was possible in 80.0% of the patients in Grenoble versus 57.9% in Lyon (P = 0.068). The rates of curative treatment were 63.6% versus 26.3% (P = 0.062) for lung cancers, 100.0% versus 87.5% (P = 0.498) for lip-mouth-pharynx and larynx cancers, and 66.7% versus 100.0% (P = 1) for esophageal cancers, respectively. In addition, for lung cancers, regardless of study group, 68.7% received a curative treatment when the diagnosis was made by CT scan screening versus 14.3% when it was made because of symptoms (P = 0.008). In conclusion, our study strongly confirms the high rate of tobacco-related de novo malignancies in LT patients for ALD and suggests that the screening of lung cancer by annual chest CT scan could significantly increase the rate of curative treatment.

• Authors: Laurence Renaud, Marie-Noëlle Hilleret, Elsa Thimonier, Olivier Guillaud, Francois Arbib, Gilbert Ferretti, Adrien Jankowski, Christine Chambon-Augoyard, Domitille Erard-Poinsot, Thomas Decaens, Olivier Boillot, Vincent Leroy, Jérôme Dumortier
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 24 Issue 12 Pg. 1690-1698 (12 2018) ISSN: 1527-6473 [Electronic] United States
• PMID: 30207421 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: Copyright © 2018 by the American Association for the Study of Liver Diseases.

Topics

• Adult
• Early Detection of Cancer
• Female
• Follow-Up Studies
• Humans
• Incidence
• Liver Diseases, Alcoholic (complications, mortality, surgery)
• Liver Transplantation
• Male
• Middle Aged
• Neoplasm Staging
• Neoplasms (diagnostic imaging, epidemiology, etiology, pathology)
• Retrospective Studies
• Risk Factors
• Smoking (adverse effects)
• Survival Rate
• Tomography, X-Ray Computed