Análisis obsevacional para evaluar la eficacia y seguridad de los mTORi en la esfera oncológica en el paciente trasplantado hepático
Background: the liver transplant patient has an extraordinary connection with the oncological sphere. On the one hand, an increasingly frequent investigation of liver transplantation is the presence of a hepatocellular carcinoma, and, on the other hand, the appearance of "de novo neoplasms" favored by the state of immunosuppression to which these patients are subjected. This close relationship with cancer is a frequent cause of death. The immunosuppressant treatment based on calcineurin inhibitor (CNI, tacrolimus, cyclosporine), controls the appearance of rejection but favor the appearance and proliferation of neoplastic cells by relaxation of the immune tumor surveillance. The appearance of mTOR inhibitors (mTORi, sirolimus, everolimus) within the immunosuppressive arsenal as non-nephrotoxic agents may represent an advance in the tumor control of these patients, since they are basically used in the area of oncology as antiproliferative agents. Objectives: 1): To analyze if the use of mTORi in the liver transplant patient by HCC reduces the incidence of recurrence and increases survival. 2): To analyze whether the use of mTORi in the liver transplant patient with de novo neoplasia reduces the incidence of recurrence and increases survival. Methodology: retrospective observational analysis of cases (patients with de novo neoplasms or those undergoing hepatic transplantation due to immunosuppressed hepatocarcinoma with mTOR inhibitors) and controls (immunosuppressed with calcineurin inhibitors), analyzing the rate of recurrence and cumulative survival. Patients: 392 patients were selected, analyzing cases and controls in two groups: patients transplanted for hepatocellular carcinoma (HCC) and patients in whom some de novo neoplasia (NN) appeared in their evolution. Results: In the HCC group, alcohol and tobacco consumption increase the incidence of HCC. (Alcohol: p = 0.035, Tobacco: p = 0.67). Vascular and capsular invasion and the Edmondson grade reduce survival (Vascular invasion: p = 0.00, appearance of the capsule: p = 0.00, Edmondson: p = 0.09). The use of CNI increases the incidence of recurrent HCC (p = 0.025). In comparison with the CNI, the mTORi increase the survival of these patients (p = 0.05). As for the NN group, alcohol consumption and tobacco consumption reduce survival after tumor diagnosis (alcohol: p = 0.02, tobacco: p = 0.001). The resection of NN, in comparison with chemotherapy and radiotherapy, increases survival (p = 0.00). The tumor stage and TNM is directly related to patient survival (p = 0.000). The use of mTORi in the immunosuppressive regimen increases the survival of liver transplant patients with de novo neoplasia compared to the use of CNI (p = 0.067).
Networked Digital Library of Theses and Dissertations