Epidemiology of de novo malignancies after solid-organ transplantation: Immunosuppression, infection and other risk factors

Piselli, Pierluca; Verdirosi, Diana; Cimaglia, Claudia; Busnach, G; Fratino, Lucia; Ettorre, Giuseppe Maria; Paoli, Paolo De; Citterio, Franco; Serraino, Diego

doi:10.1016/j.bpobgyn.2014.08.007

Cited by 45 publications

(38 citation statements)

References 97 publications

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“…Conversely, results from previous studies did not report a high excess risk of cervical cancer . To this regard, immunosuppression seems to be important in facilitating Human Papilloma Virus (HPV) replication and/or persistence by disrupting the local immunosurveillance, but it apparently has a lower effect in promoting progression to cancer . Regarding de novo liver cancer, which is strongly associated to infections with HCV and HBV, we did not find a high risk in line with other studies .…”

Section: Discussionsupporting

confidence: 79%

“…Non‐melanoma skin cancer was the most common malignancy diagnosed among the cohort members. As for immune competent individuals, prior exposure to solar ultraviolet radiation is a principal risk factor, with squamous cell carcinomas most likely to occur at sun‐exposed areas and in transplant recipients with a history of high sun exposure . In our LT population, of 50 non‐melanoma skin cancer cases, 52% were basal cell carcinoma, 32% were squamous cell carcinoma and 16% were other/not otherwise specified.…”

Section: Discussionmentioning

confidence: 91%

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Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014

Taborelli

Piselli

Ettorre

et al. 2018

Intl Journal of Cancer

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This cohort study assessed, in Italy, the overall pattern of risk of de novo malignancies following liver transplantation (LT). The study group included 2,832 individuals who underwent LT between 1985 and 2014 in nine centers all over Italy. Person-years (PYs) at cancer risk were computed from 30 days after LT to the date of cancer diagnosis, to the date of death or to the end of follow-up. Excess cancer risk, as compared to the general population, was estimated using standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). During 18,642 PYs, 246 LT recipients developed 266 de novo malignancies, corresponding to a 1.8-fold higher cancer risk (95% CI: 1.6-2.0). SIRs were particularly elevated for virus-related malignancies, including Kaposi's sarcoma (SIR = 53.6, 95% CI: 30.0-88.5), non-Hodgkin lymphomas (SIR = 7.1, 95% CI: 4.8-10.1) and cervix uteri (SIR = 5.4, 95% CI: 1.1-15.8). Among virus-unrelated malignancies, elevated risks emerged for head and neck (SIR = 4.4, 95% CI: 3.1-6.2), esophagus (SIR = 6.7, 95% CI: 2.9-13.3) and adrenal gland (SIR = 22.9, 95% CI: 2.8-82.7). Borderline statistically significant elevated risks were found for lung cancer (SIR = 1.4, 95% CI: 1.0-2.1) and skin melanoma (SIR = 2.6, 95% CI: 1.0-5.3). A reduced risk emerged for prostate cancer (SIR = 0.1, 95% CI: 0.0-0.5). These findings underline the need of preventive interventions and early detection of malignancies, specifically tailored to LT recipients.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 91%

Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014

Taborelli

Piselli

Ettorre

et al. 2018

Intl Journal of Cancer

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“…When EBV-seropositive organs have been transplanted to seronegative recipients, these patients are at higher risk of developing PTLD, especially children, who experience primary EBV infection after transplantation [25–27]. In addition to EBV, other viruses such as polyomavirus, cytomegalovirus, and HCV have also been associated with PTLD development in EBV-negative patients [5]. …”

Section: Discussionmentioning

confidence: 99%

De novo malignancy in organ transplant recipients in Taiwan: a nationwide cohort population study

et al. 2016

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Organ transplant recipients appear to have a higher risk of de novo malignancy. The aim of the study was designed to estimate cancer risk in heart, lung, kidney and liver transplant recipients. The cohort study used the Taiwan National Health Insurance Research Database (1996-2011) and followed the outcomes of organ recipients until 2012. De novo cancer and mortality rates after organ transplantation were evaluated using standardized incidence ratios, excess absolute risks of cancer, and standardized mortality ratios in recipients were compared with those in the general population. We identified 40, 231, 2, and 115 patients who developed cancer after heart, kidney, lung, and liver transplantation, which corresponded to a cancer incidence of 878.4, 1101.2, 728.9, and 1361.4 cases per 100,000 person-years, respectively. In heart, kidney, lung, and liver recipients, the overall standardized incidence ratios were 1.65 (1.21-2.24), 3.33 (2.93-3.79), 1.82 (0.45-7.27) and 3.37 (2.81-4.05) and the overall standardized mortality ratios were 5.45 (4.96-5.98), 1.47 (1.34-1.61), 8.92 (7.10-11.20), and 3.83 (3.48-4.20), respectively. These results reveal a three-fold increase in de novo cancer risk in organ transplant patients compared with the general population. This study illustrated the importance of de novo malignancy after organ transplantation.

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“…Compared to nontransplanted cancer patients, worse survival has been observed for OTRs diagnosed with colon cancer and melanoma whereas results have been mixed for nonsmall cell lung cancer . In light of these findings, it has been suggested that cancers developing in the context of transplant‐related immune suppression may have a different and more aggressive biology …”

Section: Introductionmentioning

confidence: 99%

Survival among solid organ transplant recipients diagnosed with cancer compared to nontransplanted cancer patients—A nationwide study

Benoni

Eloranta

Ekbom

et al. 2019

Intl Journal of Cancer

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Solid organ transplant recipients (OTRs) have an increased cancer risk but their survival once diagnosed with cancer has seldom been assessed. We therefore investigated cancer‐specific survival among OTRs with a wide range of cancer forms nationally in Sweden. The study included 2,143 OTRs with cancer, and 946,089 nontransplanted cancer patients diagnosed 1992–2013. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression models adjusted for age, sex and calendar year. Median follow‐up was 3.1 (range 0–22) years. Overall, OTRs diagnosed with any cancer had a 35% higher rate of cancer death compared to nontransplanted cancer patients (HR: 1.35, 95% CI: 1.24–1.47). Specifically, higher rates of cancer‐specific death were observed among OTRs diagnosed with Hodgkin lymphoma (HR: 15.0, 95% CI: 5.56–40.6), high‐grade non‐Hodgkin lymphoma (HR: 2.68, 95% CI: 1.90–3.77), malignant melanoma (HR: 2.80, 95% CI: 1.74–4.52) and urothelial (HR: 2.56, 95% CI: 1.65–3.97), breast (HR: 2.12, 95% CI: 1.38–3.25), head/neck (HR: 1.55, 95% CI: 1.02–2.36) and colorectal (HR: 1.42, 95% CI: 1.07–1.88) cancer. The worse outcomes were not explained by differences in distribution of cancer stage or histologic subtypes. For other common cancer forms such as prostate, lung and kidney cancer, the prognosis was similar to that in nontransplanted cancer patients. In conclusion, several but not all types of posttransplantation cancer diagnoses are associated with worse outcomes than in the general population. Reasons for this should be further explored to optimize posttransplantation cancer management.

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Epidemiology of de novo malignancies after solid-organ transplantation: Immunosuppression, infection and other risk factors

Cited by 45 publications

References 97 publications

Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014

Risk of virus and non‐virus related malignancies following immunosuppression in a cohort of liver transplant recipients. Italy, 1985–2014

De novo malignancy in organ transplant recipients in Taiwan: a nationwide cohort population study

Survival among solid organ transplant recipients diagnosed with cancer compared to nontransplanted cancer patients—A nationwide study

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