Surveillance of Nonmelanoma Skin Cancer Incidence Rates in Kidney Transplant Recipients in Ireland

Bannon, Finian; McCaughan, Jennifer; Traynor, Carol; O’Brien, Katie M.; Gavin, Anna; Maxwell, Alexander P.; Comber, Harry; Conlon, Peter J.

doi:10.1097/tp.0000000000000115

Cited by 14 publications

(20 citation statements)

References 26 publications

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“…There is a well‐established association between aging and cancer incidence and the association between time since transplantation, which equates to duration of immunosuppression, and risk of malignancy was evident in this cohort and has been previously recognized . A recent investigation of the long‐term risk of NMSC in an Irish kidney transplant population suggested that there was an early increase in excess risk of cancer following transplantation but that the magnitude of this excess fold risk subsequently remained constant . It is likely that the interaction between this stable transplant‐related excess risk and the exponential increase in cancer incidence, which occurs with aging, explains the relentless rise in cancer incidence in transplant patients over time.…”

Section: Discussionsupporting

confidence: 52%

“…In the study of NMSC incidence in kidney transplant recipients in Ireland, two comparable populations were managed in separate jurisdictions with different approaches to immunosuppression. There was inferior early graft survival but a significant reduction in the development of NMSC in the region with a conservative approach to immunosuppression . This suggests that the long‐term risk of cancer in recipients with an extended period of graft function may be modified by minimization of the immunosuppressive burden.…”

Section: Discussionmentioning

confidence: 99%

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The Clinical Course of Kidney Transplant Recipients After 20 Years of Graft Function

McCaughan

Courtney

2015

American Journal of Transplantation

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There is a growing population of kidney transplant recipients who have survived 20 years with a functioning graft. This study identified the factors associated with prolonged survival and described the clinical course of recipients after two decades of transplant function. All recipients transplanted in Northern Ireland between 1968 and 1993 were included (n = 706) and data were collected prospectively. At 20 years, 25% had a functioning transplant; in multivariate analysis younger recipient age and living donation were associated with 20‐year survival. The median recipient survival beyond two decades was 13.3 years; cancer was the commonest cause of death. De novo malignancy developed in 37% of recipients and cardiovascular disease in 27% after 20 years of graft function. The median graft survival after 20 years was 9.3 years; 69% of graft loss was due to death with a functioning transplant. Advances in kidney transplantation have improved the long‐term survival of both graft and recipient. After two decades the majority of patients die with a functioning graft. The focus of management in long‐term survivors may need to be on the prevention of cancer and cardiovascular disease to allow further improvements in graft and recipient survival.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

The Clinical Course of Kidney Transplant Recipients After 20 Years of Graft Function

McCaughan

Courtney

2015

American Journal of Transplantation

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“…Although era of transplantation was not a significant predictor of skin cancer, we felt it was appropriate to include it as a covariate as to account for differences in immunosuppression regimens which are known to influence the onset of NMSC posttransplant. 41 To investigate the impact of PRS on time to NMSC, we carried out a Cox proportional hazards analysis adjusting for age, era, eight PCs, and clinical center for transplantation (site) where appropriate (see Section 2,4). The Cox analysis was carried out separately for each site and then meta-analyzed across sites.…”

Section: Re Sultsmentioning

confidence: 99%

Polygenic risk score as a determinant of risk of non-melanoma skin cancer in a European-descent renal transplant cohort

Stapleton

Birdwell

McKnight

et al. 2019

American Journal of Transplantation

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Renal transplant recipients have an increased risk of non-melanoma skin cancer (NMSC) compared to in the general population. Here, we show polygenic risk scores (PRS) calculated from genome-wide association studies (GWAS) of NMSC in a general, nontransplant setting, can predict risk of, and time to posttransplant skin cancer. Genetic variants, reaching predefined P-value thresholds were chosen from published squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) nontransplant GWAS. Using these GWAS, BCC and SCC PRS were calculated for each sample across three European ancestry renal transplant cohorts (n = 889) and tested as predictors of case:control status and time to NMSC posttransplant. BCC PRS calculated at P-value threshold 1 × 10 was the most significant predictor of case:control status of NMSC posttransplant (OR = 1.61; adjusted P = .0022; AUC [full model adjusted for clinical predictors and PRS] = 0.81). SCC PRS at P-value threshold 1 × 10 was the most significant predictor of time to posttransplant NMSC (adjusted P = 9.39 × 10 ; HR = 1.41, concordance [full model] = 0.74). PRS of nontransplant NMSC is predictive of case:control status and time to NMSC posttransplant. These results are relevant to how genomics can risk stratify patients to help develop personalized treatment regimens.

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“…This is clinically significant for solid organ transplant recipients, in particular renal transplant recipients, many of whom receive long‐term immunosuppressive therapy. The incidence of cutaneous SCC in transplant patients shows marked geographic variation and has exhibited a general decline in recent years . Nonetheless, cutaneous SCC is the most common malignancy in renal transplant patients and they may still have as much as an 82‐fold increased risk for invasive cutaneous SCC compared to the general population .…”

Section: High‐risk Factors In Cutaneous Squamous Cell Carcinomamentioning

confidence: 99%

Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology

et al. 2016

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Cutaneous squamous cell carcinoma (SCC) is a malignancy that arises from epidermal keratinocytes. Although the majority of cutaneous SCC cases are easily treated without further complication, some behave more aggressively and carry a poor prognosis. These "high-risk" cutaneous SCCs commonly originate in the head and neck and have an increased tendency toward recurrence, local invasion, and distant metastasis. Factors for high-risk cutaneous SCC include large size (>2 cm), a deeply invasive lesion (>2 mm), incomplete excision, high-grade/desmoplastic lesions, perineural invasion (PNI), lymphovascular invasion, immunosuppression, and high-risk anatomic locations. Both the National Comprehensive Cancer Network (NCCN ) and the American Joint Committee on Cancer (AJCC) identify several of these high-risk features of cutaneous SCC. The purpose of this article was to review the high-risk features included in these guidelines, as well as their notable discrepancies and omissions. We also provide a brief overview of current prophylactic measures, surgical options, and adjuvant therapies for high-risk cutaneous SCC. © 2016 Wiley Periodicals, Inc. Head Neck 39: 578-594, 2017.

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Surveillance of Nonmelanoma Skin Cancer Incidence Rates in Kidney Transplant Recipients in Ireland

Cited by 14 publications

References 26 publications

The Clinical Course of Kidney Transplant Recipients After 20 Years of Graft Function

The Clinical Course of Kidney Transplant Recipients After 20 Years of Graft Function

Polygenic risk score as a determinant of risk of non-melanoma skin cancer in a European-descent renal transplant cohort

Review of high‐risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology

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