Lung Cancer Prognosis in Elderly Solid Organ Transplant Recipients

Abstract

Background Treatment-related immunosuppression in organ transplant recipients has been linked to increased incidence and risk of progression for several malignancies. Using a population-based cancer cohort, we evaluated whether organ transplantation was associated with worse prognosis in elderly patients with non-small cell lung cancer (NSCLC). Methods Using the Surveillance, Epidemiology and End Results registry linked to Medicare claims we identified 597 patients age ≥65 with NSCLC who had received organ transplants (kidney, liver, heart or lung) prior to cancer diagnosis. These cases were compared to 114,410 untransplanted NSCLC patients. We compared overall survival (OS) by transplant status using Kaplan-Meier methods and Cox regression. To account for an increased risk of non-lung cancer death (competing risks) in transplant recipients, we used conditional probability function (CPF) analyses. Multiple CPF regression was used to evaluate lung cancer prognosis in organ transplant recipients while adjusting for confounders. Results Transplant recipients presented with earlier stage lung cancer (p=0.002) and were more likely to have squamous cell carcinoma (p=0.02). Cox regression analyses showed that having received a non-lung organ transplant was associated with poorer OS (p<0.05) while lung transplantation was associated with no difference in prognosis. After accounting for competing risks of death using CPF regression, no differences in cancer-specific survival were noted between non-lung transplant recipients and non-transplant patients. Conclusions Non-lung solid organ transplant recipients who developed NSCLC had worse OS than non-transplant recipients due to competing risks of death. Lung cancer-specific survival analyses suggest that NSCLC tumor behavior may be similar in these two groups.

Pneumonia in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

“…71 Non-PTLD primary or metastatic lung cancer can also occur in SOT recipients. 72 Other complications such as pulmonary embolism, pulmonary hemorrhage, and pulmonary edema are also reported. 73,74…”

“…16 Lung transplantation poses unique challenges given the potential for donor-derived infection and recipient airway colonization to impact the occurrence and microbiology of pneumonia. In a prospective, multicenter study of pneumonia in lung transplant recipients, pneumonia incidence was 72 and viral pneumonia together accounted for 24.4% of episodes. The majority of pneumonia episodes in this series occurred in the two months post-transplant.…”

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

“…Some studies have assessed prognosis among OTRs diagnosed with a few specific cancer forms . 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 …”

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Compared to nontransplanted cancer patients, worse survival has been observed for OTRs diagnosed with colon cancer 12,14,15 and melanoma [17][18][19][20]24,26 whereas results have been mixed for nonsmall cell lung cancer. 14,22 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. 6,28 In this nationwide study, we aimed to assess if OTRs diagnosed with cancer have a worse survival compared to nontransplanted cancer patients across all major cancer types, accounting for type of transplanted organ, as well as cancer stage and histologic subtypes.…”

American Society of Nephrology Quiz and Questionnaire 2015: Transplantation

“…A study in which researchers linked data from the Surveillance, Epidemiology and End Results Registry to Medicare claims identified patients with transplants and post-transplant cancers, including nonsmall cell lung cancer. The mean time from transplant to diagnosis of lung cancer was 3.3 years in the study (7). Although lung cancer is possible, given the timing of presentation and that the patient likely had CXRs around the time of transplantation that did not show these findings, lung cancer is less likely than pneumonia (choice A is incorrect).…”