Cancer in Liver Tx Recipients
At Tx
n = 2677
128 262 387 (5%) (10%) 263 Ca (14%)
(2.8% of all pts, 19% of pts with Ca at Tx)
Tx for Liver Ca Liver Ca as a Secondary Diagnosis Total
Post Tx
Recurrent Liver Ca De Novo Ca
Skin Ca Total Multiple Ca Transferred from Donor Developed non skin Ca < 90days
Data to 31/12/2006
75 130
310 515 67 2 8
(5%) 136 Ca
(11%) (18%)
Primary Liver Cancer
n = 2677
TYPE OF CA HEPATOCELLULAR CA LAMELLA VARIANT
No 109 5
DIED 34 4
DIED OF THIS CA 19 (18%) 2 (40%)
HEPATOBLASTOMA
CARCINOID CHOLANGIOCARCINOMA
5
4 1
2
4 1
1 (20%)
4 (100%) 1 (100%)
ANGIOSARCOMA
EPITHELOID HAEMANGIOENDOTHELIOMA GASTRINOMA
1
1 1
1
0 1
1 (100%)
0 1 (100%)
PANCREATIC ISLET CELL
TOTALS
1 128 (5% of pts)
1 48 (38% of those with PCa)
1 (100%) 30 (23% of those with PCa)
Data to 31/12/2006
Overall Survival Primary Liver Cancer
100
n=128/2677 (5%)
80
% Surviving
60
40
20
No at Risk Actuarial Survival
5y 32 61
10y 9 39
15y 4 33
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Data to 31/12/2006
Years Post Tx
Primary Liver Cancer Incidence and Mortality
100
n=128/2677 (5%)
HCC (n=109) Other (n=8) Fibrolamellar (n=5) Hepatoblastoma (n=5) CC (n=1)
80
% Surviving
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years Post Tx
Data to 31/12/2006
Primary Liver Cancer Survival Summary
n = 2677
5y
n
HCC (n=110)
10yr
5
38
15yr
2
38
24
23
% Surviving n
4 38 4 80 4 60
0
2 13 3 40 4 60
2 13 2 40 2 40
Other (n=8)
% Surviving
n
Hepatoblastoma (n=5)
% Surviving
n
Fibrolamellar (n=5)
% Surviving n
CC (n=1)
% Surviving
0
Data to 31/12/2006
Primary Liver Cancer Incidence and Mortality
n=128/2677 (5%)
25 Primary Malignancy Mortality 20
15
10
5
0
Data to 31/12/2006
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Primary Liver Cancer Incidence and Mortality
n=128/2677 (5%)
20 18 16 14 12 10 8 6 4 2 0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Primary Malignancy Mortality
Data to 31/12/2006
Overall Survival Liver Cancer as a Secondary Diagnosis
100
n=262/2677 (10%)
80
% Surviving
60
40
20
No at Risk Actuarial
5y 82 68
10y 15 51
15y 2 34
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years Post Tx
Data to 31/12/2006
Liver Cancer as a Secondary Diagnosis
n = 2677
No
HEPATOCELLULAR CA* CHOLANGIO CA ADENOCARCINOMA HEPATOBLASTOMA* FIBROLAMELLAR
Died 62
Died of This Cancer
21 (9%)
230
24
3 2 2
16
3 1 1
13 (54%)
0 0 1
ANGIOSARCOMA EPITHELOID HAEMANGIOCA
1 1
263* in 262 pts (10%)
1 0
84 (33% of pts with SCa)
1 0
36 (14% of pts with SCa)
Total
* 1 patient had 2 secondary malignancies
Data to 31/12/2006
Liver Cancer as a Secondary Diagnosis
100
n = 2677
CC (n=24) HCC (n=230) Other (n=8)
80
% Surviving
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Years Post Tx
5y
n CC 5
10yr
3
15yr
1
% Surviving
n HCC
28
73
28
11
28
2
% Surviving
n Other
73
5
56
3
39
1
Data to 31/12/2006
% Surviving
60
45
45
Liver Cancer (Secondary Diagnosis) Incidence and Mortality
n=262/2677 (10%)
40
Secondary Malignancy
35
Mortality
30 25
20
15
10 5
0
1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Data to 31/12/2006
De Novo Non Skin Cancer
n = 2677
No
Alimentary* Lymphoma* 43 41
Male
29 25
Female
14 17
Age of pts (yrs)
12.6 – 74.8 (m 57) 1.5 – 65.2 (m 45)
Time to diagnosis (mths)
3 – 173 (m 59) 1 – 182 (m 40)
Died of This Cancer
22 (48%) 17 (48%)
Genitourinary*
Breast Respiratory Kaposi’s
18
8 7 5
10
4 4
8
8 3 1
38.5 – 70.5 (m 59)
39.1 – 62.8 (m 50) 44.7 – 61.1(m 56) 32.1 – 64.6 (m 50)
2 – 164 (m 29)
11 – 189 (m 79) 37 – 111(m 65) 2 – 48 (m 19)
2 (11%)
2 (25%) 5 (71%) 0
Endocrine CNS
Leukaemia
5 4
3
2 2
1
3 2
2
35.8 – 69.5 (m 59) 16.5 – 75 (m 47)
2.9 – 49.5 (m 33)
47 – 144 (m 67) 66 – 174 (m 93)
16 – 44 (m 30)
2 (40%) 2 (50%)
0
Multiple Myeloma Total
1
*136 ca in 130 pts
77
1 59
67 – 67 (m 67) 1.5 – 75 (m 52)
6 – 6 (m 6) 1 – 189 (m 53)
0
52 (40% of pts with Ca)
Eight patients also had secondary liver malignancy; * 5 patients had 2 de novo malignancies
Data to 31/12/2006
De Novo Non Skin Cancer Incidence
136 cancers in 130 pts (5% of all pts)
14
n = 2677
12 Alimentary Tract 10 Breast CNS 8 Endocrine Genitourinary 6 Kaposi's sarcoma Leukaemia 4 Lymphoma 2 Miscellaneous Respiratory 0 0-3m
Data to 31/12/2006
3-12m
1-3yr
3-5yr
5-10y
>10y
De Novo Non Skin Cancer vs All Patients
% Surviving 100
All Pts (n=2677) De Novo (n=130)
n = 2677
80
60
p=0.000
40
5y 10yr
667
15yr
214
20yr
6
20
n All Pts
1356
% Surviving
n De Novo
79
92
70
44
64
19
53
% Surviving
75
50
39
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Years Post Tx
Data to 31/12/2006
Benign Disease vs Pre Transplant Liver Malignancy
% Surviving 100
Benign disease (n=2291) Malignant disease (n=386)
Patient Survival
n = 2677
80
60
p=0.000
40
5y 10yr
645
15yr
209
20yr
7
20
Benign Disease Malignant Disease
n
1244
% Surviving
n
81
112
72
21
66
5
56
% Surviving
66
47
38
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Years Post Tx
Data to 31/12/2006
De Novo Non Skin Cancer
n = 130/2677 (5%)
Miscellaneous, 1, 1% Respiratory, 7, 5%
Lymphoma, 41, 30%
Upper GI, 13, 10%
Leukaemia, 3, 2%
Alimentary, 43, 32% Lower GI, 26, 19%
Kaposi's, 5, 4%
Genitourinary, 18, 13% Pancreas, 4, 3%
Breast, 8, 6% Endocrine, 5, 4%
Data to 31/12/2006
CNS, 4, 3%
Pre Transplant Liver Disease and De Novo Non Skin Cancer
n = 2677
PSC + Auto-immune - 42 (33%)
18 16 14 12 10 8 6 4 2 0 2 2 1 1 1 1 1 1 15 17
6 5 4 3 2 1 0
Lymphoma
HBV - 9 (8%)
5
2 1 1
Alimentary
Genitourinary
Kaposi's
Data to 31/12/2006
Lymphoma
Breast
Alimentary
Genitourinary
Kaposi's
Leukaemia
Myeloma
CNS
Endocrine
Other
Pre Transplant Liver Disease and De Novo Non Skin Cancer
n = 2677
HCV - 18 (14%)
7
Alcohol - 14 (11%)
9 8 7
8
6
6
5
5
6 3
4
5 4 3 2
3
4
2
1
1
0
1
1
Lymphoma Alimentary Genitourinary Kaposi's Leukaemia
1
Respiratory
0
1
1
1
Lymphoma
Respiratory
Alimentary
Genitourinary
Leukaemia
Data to 31/12/2006
Pre Transplant Liver Disease and De Novo Non Skin Cancer
n = 2677
35
30
25
20
Respiratory Miscellaneous Lymphoma Leukaemia Kaposi's sarcoma Genitourinary Endocrine CNS Breast Alimentary Tract
15
10
5
0
B A O H L A H H C C c hi at F FH P et M th O A O LC i Id P P T re I BV V C BC SC op er ol ab ic an cy x al M
n ig
Data to 31/12/2006
Skin Ca Post LTx
n = 2677
Type of Skin Cancer
BCC
Pts
228
Cancers
531
SCC Melanoma
Total
246 15
310 (11% of all pts)**
** 182 pts had multiple skin cancer types
** 64 pts had multiple skin cancer types
759 15
1927
Data to 31/12/2006
Time to 1st Skin Cancer Development
310 (11% of all pts)
45 BCC 40 Melanoma 35 30 25 20 15 10 5 0 0-3m
Data to 31/12/2006
n = 2677
SCC Other
3-12m
1-3yr
3-5yr
5-10y
>10y
Cumulative Risk of Diagnosis of Cancer Following Liver Tx. 1985-2006
100
Patients at Risk (2677)
80
Any Ca Skin Non skin (includes recurrent primary and secondary liver cancer) De Novo Non skin Age-Matched Gen. Pop
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Years Post Tx
Data to 31/12/2006