Sirozlu hastalarda gelişen karaciğer dışı kanserlerin özellikleri

Yıl 2018, Cilt: 17 Sayı: 3, 131 - 136, 29.12.2018

Enver Akbaş Reskan Altun Murat Korkmaz

https://doi.org/10.17941/agd.501918

Öz

Giriş
ve Amaç: Sirozlu hastalarda hepatosellüler karsinom görülme sıklığının
artmasının yanında bazı karaciğer dışı kanserlerin görülme sıklığı da
artmaktadır. Bizim merkezimizde transplantasyon öncesi takip edilen karaciğer
sirozlu hastalarda karaciğer dışı kanserlerin artıp artmadığını değerlendirdik. Gereç ve Yöntem: Bu retrospektif çalışmada
merkezimizde takip edilen 1017 sirozlu hastadan karaciğer dışı kanser gelişen
37 hastanın verileri değerlendirildi ve kanser insidans oranları belirlendi. Bu
veriler hastanemize ait kanser insidans oranları ile karşılaştırıldı. Bulgular: Karaciğer dışı kanserlerin
görülme sıklığı kontrol grubuna göre erkeklerde 4 kat, kadınlarda 9 kat,
toplamda ise 7,5 kat artmış idi (p
<0,05). Sirozlu hastalarda
kanser türlerine göre kıyaslandığında ise lösemilerde 93 kat, lenfomalarda 33
kat, safra kesesi kanserlerinde 31 kat, mide kanserlerinde 15,5 kat, renal
hücreli kanserlerde 12 kat, sarkomlarda 10 kat, mesane kanserlerinde 9 kat, pankreas,
larinks, endometrium ve akciğer kanserlerinde yaklaşık 6 kat, prostat
kanserlerinde 4 kat (p <0,05), kolon kanserlerinde 2,5 kat, meme
kanserlerinde ise 1,2 kat artış söz konusu idi (p
˃0,05). Sonuç: Sonuç
olarak sirozlu hastalarda başta lenfoma ve lösemi olmak üzere bütün karaciğer
dışı kanserlerin görülme sıklığı önemli oranda artmış olarak bulundu. 

Anahtar Kelimeler

siroz, hepatosellüler karsinom, karaciğer dışı kanserler

Characteristics of non-hepatic cancers in cirrhotic patients

Öz

Background
and Aims: Besides the incidence
of hepatocellular carcinoma, the incidence of some non-hepatic cancers also
increases in patients with cirrhosis. We evaluated whether there was an
increase in the incidence of non-hepatic cancers in patients with cirrhosis
diagnosed before transplantation in our center. Materials
and Methods: In this retrospective study, a total sample of 1017 patients with cirrhosis who were followed
up at our center was reviewed, of which the data of 37
patients who did not develop non-hepatic cancer were evaluated, and the incidence of cancer was
determined. These data were
compared with the incidence rate of cancer at our hospital.

Results: The incidence of non-hepatic cancers was found
to be increased by 4-fold in males and by 9-fold in females (overall 7.5-fold)
among patients with cirrhosis compared with that in the control group (p < 0.05).
Comparison based on the type of cancers in cirrhotic patients revealed an
increase by 93-fold for leukemia, 33-fold for lymphoma, 31-fold for gallbladder
cancers, 15.5-fold for gastric cancers, 12-fold for renal cell cancers, 10-fold
for sarcomas, 9-fold for urinary bladder cancers, ~6-fold for pancreatic,
laryngeal, endometrial, and lung cancers, 4-fold for prostate cancers (p < 0.05), 2.5-fold for colon cancers, and 1.2-fold for
breast cancers (p
˃ 0.05). Conclusion: There was an increase in the incidence of all
non-hepatic cancers, primarily lymphoma and leukemia, in patients with
cirrhosis.

Anahtar Kelimeler

Cirrhosis, non-hepatic cancers, hepatocellular carcinoma

Kaynakça

• 1. Goldberg E, Chopra S, Runyon BA. Overview of the complications, prognosis, and management of cirrhosis. UpToDate 2012.
• 2. Conn H, Atterbury C. Cirrhosis. In: Schiff L, Schiff E (Eds), Diseases of the Liver, 7th edition, Lippincott Company, Philadelphia 1993;875.
• 3. Berman K, Tandra S, Vuppalanchi R, et al. Hepatic and extrahepatic cancer in cirrhosis: a longitudinal cohortstudy. Am J Gastroenterol 2011;106:899-906.
• 4. Kalaitzakis E, Gunnarsdottir SA, Josefsson A, Björnsson E. Increased risk for malignant neoplasms among patients with cirrhosis. Clin Gastroenterol Hepatol 2011;9:168-74. Epub 2010 Oct 26.
• 5. Becker U, Tønnesen H, Kaas-Claesson N, Gluud C. Menstrual disturbances and fertility in chronic alcoholic women. Drug Alcohol Depend 1989;24:75-82.
• 6. Hara K, Kohno S, Koga H, et al. Infections in patients with liver cirrhosis and hepatocellular carcinoma. Intern Med 1995;34:491-5.
• 7. Sorensen HT, Friis S, Olsen JH, et al. Risk of liver and other types of cancer in patients with cirrhosis: A nationwide cohort study in Denmark. Hepatology 1998;28:921-5.
• 8. Heimann R. Cirrhosis and lymphoproliferative disorders. Lancet 1971;2:101.
• 9. Galun E, IlanY, Livni N. Hepatitis B virus infection associated with hematopoietic tumors. Am J Pathol 1994;145:1001-7.
• 10. Ciesek S, Helfritz FA, Lehmann U, et al. Persistence of occult hepatitis B after removal of the hepatitis B virus-infected liver. J Infect Dis 2008;197:355-60.
• 11. Yoffe B, Burns DK, Bhatt HS, Combes B. Extrahepatic hepatitis B virus DNA sequences in patients with acute hepatitis B infection. Hepatology 1990;12:187-92.
• 12. Neurath AR, Strick N, Sproul P, et al. Detection of receptors for hepatitis B virus on cells of extrahepatic origin. Virology 1990;176:448-57.
• 13. Romet-Lemonne JL, McLane MF, Elfassi E, et al. Hepatitis B virus infection in cultured human lymphoblastoid cells. Science 1983;221:667-9.
• 14. Zeldis JB, Mugishima H, Steinberg HN, et al. In vitro hepatitis B virus infection of human bone marrow cells. J Clin Invest 1986;78:411-7.
• 15. Pontisso P, Poon MC, Tiollais P, Brechot C. Detection of hepatitis B virus DNA in mononuclear blood cells. Br Med J 1984;288:1563-6.
• 16. Bouffard P, Lamelin JP, Zoulim F, et al. Phytohemagglutinin and concanavalin A activate hepatitis B virus in peripheral blood mononuclear cells of patients with chronic hepatitis B virus infection. J Med Virol 1992;37:255-62.
• 17. Yoffe B, Noonan CA, Melnick JL, Hollinger FB. Hepatitis B virus DNA in mononuclear cells and analysis of cell subsets for the presence of replicative intermediates of viral DNA. J Infect Dis 1986;153:471-7.
• 18. Stoll-Becker S, Repp R, Glebe D, et al. Transcription of hepatitis B virus in peripheral blood mononuclear cells from persistently infected patients. J Virol 1997;71:5399-407.
• 19. Pontisso P, Vidalino L, Quarta S, Gatta A. Biological and clinical implications of HBV infection in peripheral blood mononuclear cells. Autoimmun Rev 2008;8:13-7.
• 20. Michalak TI, Pasquinelli C, Guilhot S, Chisari FV. Hepatitis B virus persistence after recovery from acute viral hepatitis. J Clin Invest 1994;93:230-9.
• 21. Anderson LA, Pfeiffer R, Warren JL, et al. Hematopoietic malignancies associated with viral and alcoholic hepatitis. Cancer Epidemiol Biomarkers Prev 2008;17:3069-75.
• 22. Ferri C, La Civita L, Caracciolo F, Zignego AL. Non-Hodgkins lymphoma: a possible role of hepatitis C virüs infection. JAMA 1994;272:355-6.
• 23. Ferri C, Caracciolo F, Zignego AL, et al. Hepatitis C virus infection in patients with non-Hodgkins lymphoma. Br J Haematol 1994;88:392-4.
• 24. Luppi M, Ferrari MG, Bonaccorsi G, et al. Hepatitis C virus infection in subsets of neoplastic lymphoproliferations not associated with cryoglobulinemia. Leukemia 1996;10:351-5.
• 25. Ferri C, La Civita L, Monti M, et al. Can type C hepatitis be complicated by B-cell malignant lymphoma? Lancet 1995;346:1426-7.
• 26. Ferri C, La Civita L, Monti M, et al. B-cell non-Hodgkins lymphoma complicating type C chronic hepatitis. Q J Med 1996;89:117-22.
• 27. Ellenrieder V, Beckh K, Muller D, et al. Intrahepatic high-grade malignant non-Hodgkin lymphoma in a patient with chronic hepatitis C infection. Z Gastroenterol 1996;34:283-5.
• 28. Fink FM, Hocker-Schulz S, Mor W, et al. Association of hepatitis C virus infection with chronic liver disease in paediatric cancer patients. Eur J Pediatr 1993;152:490-2.
• 29. Heimann R, Lespagnard L, Dargent JL, Desmet VJ. Is there a link between viral hepatitis and lymphoproliferative disorders? From the autopsy room to the PCR thermal cycler. (Review).Curr Diagn Pathol 1996;3:177-81.
• 30. Izumi T, Sasaki R, Miura Y, Okamoto H. Primary hepato-splenic lymphoma: association with hepatitis C virus infection. Blood 1996;87:5380-1.
• 31. Izumi T, Sasaki R, Tsunoda S, et al. B-cell malignancy and hepatitis C virus infection. Leukemia 1997;11(Suppl 3):516-8.