Abstract: Clinicopathological features, postoperative recovery and prognosis of de novo colorectal cancer after solid organ transplantation: a cohort study based on propensity matching analysis        LYU Yang, TANG Wen-tao, XU Ping-ping, et al. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: XU Jian-min, E-mail: xujmin@aliyun.com
Abstract    Objective    To evaluate the difference of clinicopathological features and prognosis between sporadic colorectal cancer and de novo colorectal cancer after solid organ transplantation. Methods    Patients’ characteristics were analyzed retrospectively. 21 patients with de novo colorectal cancer after solid organ transplantation admitted to Zhongshan Hospital of Fudan University from January 2004 to December 2020 were collected, and a total of 84 patients with sporadic colorectal cancer who underwent primary resection between 2008 and 2013 were matched according to the ratio of 1∶4 by propensity matching analysis. Kaplan‑Meier method was used to calculate the survival rate and draw the survival curve. The Log‑rank test was used for survival analysis. Results    Among the 21 patients with new colorectal cancer after solid organ transplantation, 18 patients were males and 3 were females; The median age was 60.2 years, ranging from 43 to 73 years. 11 cases underwent liver transplantation, 5 cases underwent kidney transplantation, and 5 cases underwent heart transplantation. After matching, compared with the intraoperative situation, patients in the transplantation group had longer operation time, higher incidence of surgery-related complications, such as anastomotic fistula, side injury and gastrointestinal motility disorder (ALL P<0.001). In terms of recovery, the postoperative exhaust recovery time (2.8 d vs. 2.1 d), postoperative diet recovery time (4.2 d vs. 3.6 d) and postoperative hospital stay (11.5 d vs. 7.8 d) in the transplantation group were significantly higher than those in the sporadic group. For long-term prognosis, there was no significant difference in disease-free survival (55 months vs. 58 months) and overall survival (118 months vs. None) between two groups (P>0.05). Conclusion    For de novo colorectal cancer after solid organ transplantation, the postoperative recovery was statistically worse, and their long-term survival outcomes were similar to that of sporadic colorectal cancer patients. Strict postoperative management is very necessary for de novo colorectal cancer patients.

Key words: solid organ transplantation, colorectal cancer, prognosis, clinical pathological characteristics

摘要： 目的    对比分析实体器官移植术后新发结直肠癌与散发结直肠癌的临床病理特征及预后差异。方法      回顾性分析2004—2020复旦大学附属中山医院收治的21例行实体器官移植术后新发结直肠癌病人（移植术后新发组）的临床病理资料，并采用倾向性评分匹配方法，从2008—2013年行原发灶切除的散发结直肠癌病例中按照1∶4的比例匹配84例病人作为对照（散发组）。比较两组病人术中及术后情况，采用Kaplan‑Meier法计算生存率和绘制生存曲线，采用Log‑rank检验进行生存分析。结果    21例实体器官移植术后新发结直肠癌病人中，男性18例，女性3例；年龄60.2（43~73）岁；其中11例既往行肝移植手术，5例行肾移植手术，5例行心脏移植手术。倾向性评分匹配后，与散发组比较，移植术后新发组病人手术时间延长，手术相关并发症（吻合口漏、副损伤、胃肠动力障碍）发生率更高，术后恢复排气和饮食时间、术后住院时间均延长，组间差异均有统计学意义（P<0.05）。两组中位无病生存期（55个月 vs. 58个月）和总体生存期（118个月 vs. 未达到中位生存期）差异均无统计学意义（P>0.05）。结论    与散发结直肠癌相比，实体器官移植术后新发结直肠癌病人行根治性切除手术后并发症增加，术后恢复明显较慢，但二者远期生存相同。因此，对于此类病人须进行严格的术后管理。

关键词: 实体器官移植, 结直肠癌, 预后, 临床病理因素