Retrospective study of the incidence and outcomes from lung cancer in solid organ transplant recipients
Introduction
Solid organ transplant recipients (OTR) have an increased incidence of developing a malignancy post-transplant, which is the 2nd leading cause of mortality in transplant patients [1,2]. The increased risk is thought to be largely due to immunosuppression in transplant patients, allowing more cancers to escape immune surveillance, similar to other immunosuppressed populations (e.g. patients with HIV) [3]. Other theories include local immune reactions against the transplanted organ, carcinogenicity of immunosuppressants, increased surveillance, and risk from the underlying conditions that led to the need for an organ transplant [[4], [5], [6], [7]] Lung cancer is one of the most common malignancies seen in OTR’s after hematological and skin cancers. However, there is a paucity of studies evaluating treatment and outcomes from lung cancer in patients with an organ transplant [1,2].
The University Health Network (UHN) has one of the largest transplant centres in North America. In this retrospective study, we investigated the incidence, treatment and survival outcomes of patients with post-transplant lung cancers in UHN from 1980 to 2016.
Section snippets
Study population
This was a retrospective study, which included all patients who received a solid organ (heart, liver, lung or kidney) transplant at the University Health Network, Toronto, CA from January 1, 1980 to June 30, 2016 and diagnosed with a post-transplant non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC) or lung neuroendocrine tumor (NET) (Fig. 1). Patients with insufficient available data critical for our analyses, due to follow up at another institution, were excluded from the
Results
Of the 7944 patients who underwent a solid organ transplant, 123 patients (1.5 %) were diagnosed with a primary lung malignancy of which 101 (1.3 %) were included in our analysis (Fig. 1). Patient baseline characteristics are described in Table 1. The median time from transplant to cancer diagnosis was 60 months (excluding those diagnosed in the removed/explanted lung. The majority of the lung cancers were NSCLC (82 cases); with 11 cases of SCLC and 8 cases of NETs (typical carcinoid).
Discussion
This retrospective, single institution study evaluated the outcome and treatments administered in a cohort of 101 patients diagnosed with lung cancer after a solid organ transplant. Overall outcomes were poor for patients with stage I-II NSCLC, having a median OS of 25 months and for patients with stage IV disease, 3 months. Patients with SCLC similarly had a poorer OS. Systemic therapy was administered to a minority of patients, however some patients included in this analysis were treated
Conclusions
In patients diagnosed with lung cancer after a prior organ transplant, we found shorter survival in general compared to historical norms for patients with particularly early stage NSCLC despite surgical resection or radiation. Patients with stage III disease, and in the selected patients that received palliative chemotherapy for NSCLC and SCLC, outcomes were similar (for stage III), or on the lower range of what may be expected at the time for non-OTR patients, however, only a minority of NSCLC
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Kelvin Young: Conceptualization, Visualization, Methodology, Investigation, Writing - original draft, Writing - review & editing. Haiyan Jiang: Formal analysis, Writing - review & editing. Max Marquez: Data curation, Writing - review & editing. Jonathan Yeung: Writing - review & editing. Frances A. Shepherd: Writing - review & editing. Eberhard Renner: Writing - review & editing. Shaf Keshavjee: Writing - review & editing. Joseph Kim: Writing - review & editing. Heather Ross: Writing - review &
Declaration of Competing Interest
None.
References (33)
- et al.
Cancer incidence among canadian kidney transplant recipients
Am. J. Transplant.
(2007) Effect of long-term immunosuppression in kidney-graft recipients on cancer incidence: randomised comparison of two cyclosporin regimens
Lancet
(1998)- et al.
Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients
Lancet
(1993) - et al.
Stage III non-small-Cell lung Cancer: population-Based patterns of treatment in British Columbia, Canada
J. Thorac. Oncol.
(2012) - et al.
De novo solid malignancies after cardiac transplantation
Ann. Thorac. Surg.
(1995) - et al.
Primary lung cancer in lung transplant recipients
Ann. Thorac. Surg.
(2014) - et al.
Bronchogenic carcinoma after lung transplantation: characteristics and outcomes
J. Thorac. Oncol.
(2008) - et al.
Cancer mortality in kidney transplantation
Am. J. Transplant.
(2009) - et al.
Liver transplantation-associated lung cancer: comparison of clinical parameters and outcomes
Clin. Lung Cancer
(2015) - et al.
Immune checkpoint inhibitor therapy in solid organ transplant recipients: a patient-centered systematic review
J. Am. Acad. Dermatol.
(2020)
Risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008—a Swedish population-based study
Int. J. Cancer
Skin Cancer’s ranks rise
JAMA
Cancer incidence before and after kidney transplantation
JAMA
Cyclosporine induces cancer progression by a cell-autonomous mechanism
Nature
Is there a survival benefit in patients with stage IIIA (N2) non-small cell lung Cancer Receiving neoadjuvant chemotherapy and/or radiotherapy prior to surgical resection
Medicine
Meta-analysis of randomized clinical trials comparing cisplatin to carboplatin in patients with advanced non–Small-Cell lung Cancer
J. Clin. Oncol.
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