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Patini R, Cordaro M, Marchesini D, Scilla F, Gioco G, Rupe C, D'Agostino MA, Lajolo C. Is Systemic Immunosuppression a Risk Factor for Oral Cancer? A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:3077. [PMID: 37370688 DOI: 10.3390/cancers15123077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Even if the relationship between immunosuppression and increased incidence of systemic cancers is well known, there is less awareness about the risk of developing oral cancer in immunosuppressed patients. The aim of this review was to evaluate the association between immunosuppression and the development of oral cancer. Two authors independently and, in duplicate, conducted a systematic literature review of international journals and electronic databases (MEDLINE via OVID, Scopus, and Web of Science) from their inception to 28 April 2023. The assessment of risk of bias and overall quality of evidence was performed using the Newcastle-Ottawa Scale and GRADE system. A total of 2843 articles was identified, of which 44 met the inclusion criteria and were included in either the qualitative or quantitative analysis. The methodological quality of the included studies was generally high or moderate. The quantitative analysis of the studies revealed that immunosuppression should be considered a risk factor for the development of oral cancer, with a percentage of increased risk ranging from 0.2% to 1% (95% CI: 0.2% to 1.4%). In conclusion, the results suggest that a constant and accurate follow-up should be reserved for all immunosuppressed patients as a crucial strategy to intercept lesions that have an increased potential to evolve into oral cancer.
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Affiliation(s)
- Romeo Patini
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Massimo Cordaro
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Denise Marchesini
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Francesco Scilla
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Gioele Gioco
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Cosimo Rupe
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Maria Antonietta D'Agostino
- Department of Geriatric and Orthopedic Sciences, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
| | - Carlo Lajolo
- Department of Head, Neck and Sense Organs, School of Dentistry, Catholic University of Sacred Heart, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS Rome, 00135 Rome, Italy
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Schnitzbauer AA, Filmann N, Adam R, Bachellier P, Bechstein WO, Becker T, Bhoori S, Bilbao I, Brockmann J, Burra P, Chazoullières O, Cillo U, Colledan M, Duvoux C, Ganten TM, Gugenheim J, Heise M, van Hoek B, Jamieson N, de Jong KP, Klein CG, Klempnauer J, Kneteman N, Lerut J, Mäkisalo H, Mazzaferro V, Mirza DF, Nadalin S, Neuhaus P, Pageaux GP, Pinna AD, Pirenne J, Pratschke J, Powel J, Rentsch M, Rizell M, Rossi G, Rostaing L, Roy A, Scholz T, Settmacher U, Soliman T, Strasser S, Söderdahl G, Troisi RI, Turrión VS, Schlitt HJ, Geissler EK. mTOR Inhibition Is Most Beneficial After Liver Transplantation for Hepatocellular Carcinoma in Patients With Active Tumors. Ann Surg 2020; 272:855-862. [PMID: 32889867 DOI: 10.1097/sla.0000000000004280] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). SUMMARY AND BACKGROUND DATA Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data. PATIENTS AND METHODS Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence. RESULTS Sirolimus use for ≥3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52-0.96, P = 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) ≥10 ng/mL and having used sirolimus for ≥3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49-0.59, P = 0.0079-0.0245). CONCLUSIONS mTOR-inhibitor treatment with sirolimus for ≥3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients. CLINICAL TRIAL REGISTRATION EudraCT: 2005-005362-36 CLINICALTRIALS.GOV:: NCT00355862.
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Affiliation(s)
- Andreas A Schnitzbauer
- Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Frankfurt am Main, Germany
| | - Natalie Filmann
- Universitätsklinikum Frankfurt, Institut für Biostatistik und Mathematisches Modellierung, Frankfurt am Main, Germany
| | - René Adam
- Hôpital Paul Brousse, Centre Hépato Biliaire, Paris, France
| | - Philippe Bachellier
- Les Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service de Chirurgie Générale, Hépatique, Endocrinienne, et Transplantation, Strasbourg, France
| | - Wolf O Bechstein
- Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Frankfurt am Main, Germany
| | - Thomas Becker
- Universitätsklinikum Schleswig-Holstein - Campus Kiel, Klinik für Allgemeine Chirurgie, Viszeral-, Thorax, Transplantations- und Kinderchirurgie, Kiel, Germany
| | - Sherrie Bhoori
- Fondazione IRCCS Istituto Nazionale dei Tumori, National Cancer Institute Milan, Department of Surgery, Transplantation and Hepatobiliary Cancer Unit, Milano, Italy
| | - Itxarone Bilbao
- Hospital Universitari Vall d'Hebron, Servicio de Cirugía General, Unidad de Trasplante Hepatico, Barcelona, Spain
| | - Jens Brockmann
- Universitätsklinikum Münster, Klinik für Allgemein- und ViszeralchirurgieMünster, Germany
| | - Patrizia Burra
- Università degli Studi di Padova, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche (DiSCOG), Padova, Italy
| | - Olivier Chazoullières
- Hôpital Saint Antoine, Federation d'Hepato-Gastro-Enterologie, Service d'Hepatologie, Paris, France
| | - Umberto Cillo
- Università di Padova, Azienda Ospedaliera di Padova, Chirurgia Epatobiliare e Trapianto Epatico, Padova, Italy
| | - Michele Colledan
- Azienda Ospedaliera Papa Giovanni XXIII, Chirurgia terza e Chirurgia Toracica, Bergamo (BG), Italy
| | - Christoph Duvoux
- Université Paris-Est Créteil Val-de-Marne, Centre Hospitalier Universitaire Henri-Mondor, Service d'Hepatologie et de Gastroenterologie, Unite d'Hepatologie et de Transplantation Hepatique, Paris, France
| | - Tom M Ganten
- Universitätsklinikum Heidelberg, Fürst Stirum Klinik Bruchsal, Bruchsal, Germany
| | - Jean Gugenheim
- Centre Hospitalier Universitaire de Nice, Hôpital ARCHET 2, Service de Chirurgie Digestive, Centre de Transplantation Hépatique, Nice Cedex, France
| | - Michael Heise
- Universitätsklinikum Frankfurt, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Frankfurt am Main, Germany
| | - Bart van Hoek
- Leiden University Medical Center (LUMC), Dept. of Gastroenterology and Hepatology, Leiden, Netherlands
| | - Neville Jamieson
- Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke's Hospital, Department of Surgery, Hills Road, Cambridge, United Kingdom
| | - Koert P de Jong
- University Medical Center Groningen, University of Groningen, Department of Surgery, Div. of Hepato-Pancreatico-Biliary Surgery & Liver Transplantation, Groningen, Netherlands
| | - Christian G Klein
- Universitätsklinikum Essen, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Essen, Germany
| | - Jürgen Klempnauer
- Medizinische Hochschule Hannover, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany
| | - Norman Kneteman
- University of Alberta, Alberta Health Services Liver Transplant Program, Alberta, Canada
| | - Jan Lerut
- Institute for Experimental and Clinical Research (IREC), Université catholique Louvain(UCL), Brussels, Belgium
| | - Heikki Mäkisalo
- Helsinki University Central Hospital, Division of Transplantation and Liver Surgery, Helsinki, Finland
| | - Vincenzo Mazzaferro
- Fondazione IRCCS Istituto Nazionale dei Tumori, National Cancer Institute Milan, Department of Surgery, Transplantation and Hepatobiliary Cancer Unit, Milano, Italy
| | - Darius F Mirza
- University Hospitals Birmingham, NHS Foundation Trust, The Queen Elizabeth Hospital, Liver and Hepato-Pancreato-Biliary (HPB) Unit, Edgbaston, Birmingham, United Kingdom
| | - Silvio Nadalin
- Klinikum der Universität Tübingen, Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Tübingen, Germany
| | - Peter Neuhaus
- Charité Campus Virchow Klinikum, Universitätsmedizin Berlin, Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Berlin, Germany
| | - George-Philippe Pageaux
- CHRU de Montpellier, APEMAD, Hôpital Saint-Eloi, Service d'Hepato-Gastroentérologie et Transplantation Hepatique, Cedex 5, France
| | - Antonio D Pinna
- Universita di Bologna, Policlinico S. Orsola-Malpighi, Chirurgia Generale e dei Trapianti, Bologna, Italy
| | - Jaques Pirenne
- UZ Leuven, Campus Gasthuisberg, Abdominale Transplantatiechirurgie, Leuven, Belgium
| | - Johann Pratschke
- Charité - Universitätsmedizin Berlin Augustenburger Platz 1, 13353 Berlin
| | - James Powel
- Royal Infirmary of Edinburgh, NHS Lothian, Hepatic-Pancreatico-Biliary Surgical Services and Edinburgh Transplant Unit, 51 Little France Crescent, Edinburgh, Scotland, United Kingdom
| | - Markus Rentsch
- Klinikum der Ludwig-Maximillians-Universität München-Großhadern, current affiliation: Klinikum Ingolstadt, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Ingolstadt, Germany
| | - Magnus Rizell
- Sahlgrenska University Hospital, Department of Surgery and Transplantation, Göteborg, Sweden
| | - Giorgio Rossi
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico IRCCS di Milano, Centro Trapianti Fegato, Pad Zonda I piano, Milano, Italy
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Transplantation, Grenoble-Alpes University Hospital Center, Avenue du Maquis du Grésivaudan, La Tronche, France
| | - André Roy
- Hopital St Luc, Centre Hospitalier de l'Université Montréal (CHUM), Hepatobiliary and Pancreatic Surgery Unit, Principal Pavillion, 1058 Rue St Denis Montreal, Quebec, Canada
| | - Tim Scholz
- Uppsala University Hospital, Deptartment for Transplant Surgery, Uppsala, Sweden
| | - Utz Settmacher
- Universitätsklinikum Jena, Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Jena, Germany
| | - Thomas Soliman
- Medizinische Universität Wien, AKH- Wien, Universitätsklinik für Chirurgie, Abteilung für Transplantation, Vienna, Austria
| | - Simone Strasser
- Royal Prince Alfred Hospital, AW Morrow Gastroenterology, and Liver Centre and Liver Transplant Unit, Camperdown, Sydney, Australia
| | - Gunnar Söderdahl
- Karolinska University Hospital, Department of Transplantation Surgery, Stockholm, Sweden
| | - Roberto I Troisi
- Ghent University Hospital and Medical School, Hepato- Biliary and Pancreatic Surgery, Ghent, Belgium
| | - Victor Sánchez Turrión
- Hospital Universitario Puerta de Hierro-Majadahonda, Departamento de Cirugía, Unidad de Trasplante Hepático, Calle Manuel de Falla 1, Madrid, Spain
| | - Hans J Schlitt
- University Hospital Regensburg, Department of Surgery, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
| | - Edward K Geissler
- University Hospital Regensburg, Department of Surgery and Section of Experimental Surgery, Franz-Josef-Strauss-Allee 11, Regensburg, Germany.,Division of Tumor Therapy, Fraunhofer Institute of Experimental Medicine and Toxicology, Regensburg, Germany
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