Immune‐related conditions and cancer‐specific mortality among older adults with cancer in the United States

Wang, Jeanny H; Derkach, Andriy; Pfeiffer, Ruth M.; Engels, Eric A.

doi:10.1002/ijc.34140

Cited by 6 publications

(5 citation statements)

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“…Among recipients, the elevated mortality from cancer is explained by their increased incidence for certain cancers and decreased survival after a cancer diagnosis, each of which is plausibly related to immunosuppression from medications used to prevent organ rejection. [1][2][3][4][5][6][7] Consistent with findings in other studies, [8][9][10] we also saw a decline in overall cancer mortality in more recent calendar years. Although this trend could reflect the effects of decreasingly intense immunosuppressive regimens in recent years, cancer incidence has not changed markedly over time.…”

Section: Discussionsupporting

confidence: 91%

“…[1][2][3][4] In addition to increasing the risk for cancer, immunosuppression may impair response to cancer treatment because a history of solid organ transplantation among patients with cancer is associated with reduced survival from their cancer. [5][6][7] Many studies provide estimates of cancer incidence in recipients, [1][2][3] but it is also necessary to systematically evaluate cancer mortality. Cancer mortality is an important metric that quantifies the overall impact of cancer in a population, encompassing the effects of cancer incidence, response to cancer treatment, and survival after cancer diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…1-4 In addition to increasing the risk for cancer, immunosuppression may impair response to cancer treatment because a history of solid organ transplantation among patients with cancer is associated with reduced survival from their cancer. 5-7…”

Section: Introductionmentioning

confidence: 99%

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Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987–2018

et al. 2023

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Background. Solid organ transplant recipients (ie, “recipients”) have elevated cancer risk and reduced survival after a cancer diagnosis. Evaluation of cancer mortality among recipients can facilitate improved outcomes from cancers arising before and after transplantation. Methods. We linked the US transplant registry to the National Death Index to ascertain the causes of 126 474 deaths among 671 127 recipients (1987–2018). We used Poisson regression to identify risk factors for cancer mortality and calculated standardized mortality ratios to compare cancer mortality in recipients with that in the general population. Cancer deaths verified with a corresponding cancer diagnosis from a cancer registry were classified as death from pretransplant or posttransplant cancers. Results. Thirteen percent of deaths were caused by cancer. Deaths from lung cancer, liver cancer, and non-Hodgkin lymphoma (NHL) were the most common. Heart and lung recipients had the highest mortality for lung cancer and NHL, whereas liver cancer mortality was highest among liver recipients. Compared with the general population, cancer mortality was elevated overall (standardized mortality ratio 2.33; 95% confidence interval, 2.29-2.37) and for most cancer sites, with large increases from nonmelanoma skin cancer (23.4, 21.5-25.5), NHL (5.17, 4.87-5.50), kidney cancer (3.40, 3.10-3.72), melanoma (3.27, 2.91-3.68), and, among liver recipients, liver cancer (26.0, 25.0-27.1). Most cancer deaths (93.3%) were associated with posttransplant cancer diagnoses, excluding liver cancer deaths in liver recipients (of which all deaths were from pretransplant diagnoses). Conclusions. Improved posttransplant prevention or screening for lung cancer, NHL, and skin cancers and management of liver recipients with prior liver cancer may reduce cancer mortality among recipients.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987–2018

et al. 2023

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“…In a national, matched cohort study with the United States (US) Veterans Health Administration database from 2000 to 2017, Johnson et al showed that approximately 15% of excess deaths in RA were attributed to lung cancer (adjusted HR 1.47 [95% CI 1.37–1.57] vs. non-RA patients) [ 10 ]. In a retrospective cohort study with the Surveillance, Epidemiology, and End Results-Medicare database in the US from 1993 to 2013, Wang et al showed that RA was associated with increased cancer-specific mortality among elderly patients with lung cancer (adjusted HR 1.13 [95% CI 1.09–1.16]) [ 42 ]. The present study was conducted in patients who developed lung cancer during 2006–2021, and the risk of lung cancer-related death was significantly higher in RA patients compared with non-RA patients (adjusted HR 2.49 [95% CI 1.65–4.79]).…”

Section: Discussionmentioning

confidence: 99%

Impact of combined pulmonary fibrosis and emphysema on lung cancer risk and mortality in rheumatoid arthritis: A multicenter retrospective cohort study

Mori,

Ueki,

Hasegawa

et al. 2024

PLoS ONE

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Objective Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome characterized by the coexistence of emphysema and fibrotic interstitial lung disease (ILD). The aim of this study was to examine the effect of CPFE on lung cancer risk and lung cancer-related mortality in patients with rheumatoid arthritis (RA). Methods We conducted a multicenter retrospective cohort study of patients newly diagnosed with lung cancer at five community hospitals between June 2006 and December 2021. Patients were followed until lung cancer-related death, other-cause death, loss to follow-up, or the end of the study. We used the cumulative incidence function with Gray’s test and Fine-Gray regression analysis for survival analysis. Results A total of 563 patients with biopsy-proven lung cancer were included (82 RA patients and 481 non-RA patients). The prevalence of CPFE was higher in RA patients than in non-RA patients (40.2% vs.10.0%) at lung cancer diagnosis. During follow-up, the crude incidence rate of lung cancer-related death was 0.29 and 0.10 per patient-year (PY) in RA and non-RA patients, and 0.32 and 0.07 per PY in patients with CPFE and patients without ILD or emphysema, respectively. The estimated death probability at 5 years differed between RA and non-RA patients (66% vs. 32%, p<0.001) and between patients with CPFE and patients without ILD or emphysema (71% vs. 24%, p<0.001). In addition to clinical cancer stage and no surgery within 1 month, RA and CPFE were identified as independent predictive factors for increased lung cancer-related mortality (RA: adjusted hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.65–4.76; CPFE: adjusted HR 2.01; 95% CI 1.24–3.23). Conclusions RA patients with lung cancer had a higher prevalence of CPFE and increased cancer-related mortality compared with non-RA patients. Close monitoring and optimal treatment strategies tailored to RA patients with CPFE are important to improve the poor prognosis of lung cancer.

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“…The frequency and distribution of individual autoimmune diseases in our cohort was as expected based on the population’s age and existing reports on preexisting autoimmune disease in MDS. 16 , 34 Defining the impact of autoimmune disease on MDS outcomes is important, given the sizable proportion of patients affected. Previous studies have shown discordant results; some suggest a favorable impact on survival, 15 , 16 whereas others found an adverse effect 13 , 14 or no effect.…”

Section: Discussionmentioning

confidence: 99%

Impact of preexisting autoimmune disease on myelodysplastic syndromes outcomes: a population analysis

Adrianzen-Herrera,

Sparks,

Singh

et al. 2023

Blood Advances

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Preexisting autoimmune disease affects 10-30% of patients with myelodysplastic syndromes (MDS). Studies comparing outcomes in MDS patients with and without autoimmune disease show discordant results. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare, we conducted a population analysis to define the impact of autoimmunity on MDS outcomes. Cases were ascertained between 2007 - 2017 and claim algorithms employed to identify autoimmune disease, demographic characteristics, comorbidity scores, MDS histology, transfusion burden, treatment with hypomethylating agents and hematopoietic stem cell transplant. Cox regression models estimated the impact on survival and competing-risk regression models defined the effect on leukemic transformation. We analyzed 15,277 MDS patients, including 2,442 (16%) with preexisting autoimmune disease. The epidemiologic profile was distinctive in cases with preexisting autoimmunity, who were younger, predominantly female and had higher transfusion burden without difference in MDS histologic distribution. Autoimmune disease was associated with 11% decreased risk of death (hazard ratio [HR] 0.89, 95% confidence interval [CI], 0.85 - 0.94, p<0.001). The effect on risk of leukemic transformation differed based on MDS histology. In low-risk MDS histologies, autoimmunity was associated with a 1.9-fold increased risk of leukemia (HR 1.87, 95%CI, 1.17 - 2.99, p=0.008), while no significant effect was seen in other groups. These results suggest that autoimmune disease affects survival in MDS and is associated with decreased mortality. The survival effect was evident in low risk histologies despite higher risk of progression to leukemia. This could represent inflammation-driven hematopoiesis simultaneously favoring less aggressive phenotypes and clonal expansion, which warrants further investigation.

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Immune‐related conditions and cancer‐specific mortality among older adults with cancer in the United States

Cited by 6 publications

References 50 publications

Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987–2018

Cancer Mortality Among Solid Organ Transplant Recipients in the United States During 1987–2018

Impact of combined pulmonary fibrosis and emphysema on lung cancer risk and mortality in rheumatoid arthritis: A multicenter retrospective cohort study

Impact of preexisting autoimmune disease on myelodysplastic syndromes outcomes: a population analysis

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