Survival Outcomes After Double-Lung Transplantation for Refractory Lung-Limited Cancers and Incidence of Post-Transplant Lung Cancer

Lee, Jeeyeon; Aguilera Chuchuca, Maria Jose; Yu, Jisang; Chung, Liam Il-Young; Bharat, Ankit; Chae, Young Kwang

doi:10.12659/aot.941301

Cited by 4 publications

(4 citation statements)

References 26 publications

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“…The promising preliminary data from this trial are anticipated to provide a more in-depth understanding of Pre-TM's impacts on transplant outcomes, paving the way for enhanced patient selection criteria and posttransplant care. 21 This study faces several limitations that warrant careful consideration. Firstly, the classification of Pre-and Post-TM was based solely on the organ system, lacking detailed histologic, biologic, and staging information crucial for predicting patient's prognosis.…”

Section: Discussionmentioning

confidence: 95%

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Rethinking the Impact of Pretransplant Malignancy (Pre-TM) on Double Lung Transplantation (DLT) Eligibility: An Analysis of 23,291 DLT Recipients

Woo,

Kim,

Bharat

et al. 2024

Preprint

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Background: Given the increasing need for lung transplants among older patients with a history of cancer, this study analyzed database registry to assess outcomes for DLT recipients with Pre-TM. Methods: This study evaluated the United Network for Organ Sharing (UNOS) registry for adult DLT performed between 2005 and 2023. Patients with a history of previous or multi-organ transplants, and those with donors who had cancer history, were excluded. Propensity-score matching was used to compare patients with or without Pre-TM. Overall and Post-TM-free survival were analyzed. Results: Among the 23,291 recipients of DLT, 8.0%(1,870) had Pre-TM. Compared to those without Pre-TM, patients with Pre-TM had worse overall (hazard ratio[HR] 1.20, 95% confidence interval[CI] 1.12-1.29, p<0.001) and Post-TM-free survival (HR 1.32, 95% CI 1.24-1.41, p<0.001). However, after adjusting for age, sex, and race through propensity-score matching, the survival difference between the groups became non-significant (HR 1.05, 95% CI 0.97-1.13, p=0.229). While the Pre-TM group still had worse Post-TM-free survival, this difference diminished after excluding cutaneous Post-TM (HR 1.06, 95% CI 0.99-1.15, p=0.116). Additionally, the recurrence rate of Pre-TM after transplant wasn't higher than de novo cancers in patients without Pre-TM. Conclusion: Patients with Pre-TM had similar overall survival rates after DLT as those without Pre-TM. Importantly, there is no increased risk of the primary Pre-TM type recurring post-transplant compared to patients without Pre-TM. These findings highlight the necessity for a more nuanced evaluation of transplant candidacy to prevent premature exclusion of Pre-TM patients from life-saving surgeries.

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Section: Discussionmentioning

confidence: 95%

“…The promising preliminary data from this trial are anticipated to provide a more in-depth understanding of Pre-TM’s impacts on transplant outcomes, paving the way for enhanced patient selection criteria and post-transplant care. 21…”

Section: Discussionmentioning

confidence: 99%

Rethinking the Impact of Pretransplant Malignancy (Pre-TM) on Double Lung Transplantation (DLT) Eligibility: An Analysis of 23,291 DLT Recipients

Woo,

Kim,

Bharat

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

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“…41 Recent advancements in technology and survival of lung transplant could also selectively be applied to some patients. 42,43 The integration of liquid biopsy in PM has brought new insights into this field.…”

Section: Discussionmentioning

confidence: 99%

“…41 Recent advancements in technology and survival of lung transplant could also selectively be applied to some patients. 42,43…”

Section: Discussionmentioning

confidence: 99%

The role of pulmonary metastasectomy (PM) for non-primary lung cancer: Umbrella review of meta-analyses

Woo,

Park,

Ahadi

et al. 2024

Preprint

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Introduction: Due to heterogeneous characteristics of primary cancers, the efficacy of pulmonary metastasectomy(PM) in non-primary lung cancers has not been investigated other than colorectal cancers. This study aims to investigate the clinical outcomes of PM for non-primary lung cancer. Methods: A systematic search for meta-analyses on PM for non-primary lung cancers was conducted, encompassing publications up to January 3, 2024. The analysis included seven primary cancer types: renal cell, breast, adrenocortical, head and neck cancers, melanoma, germ cell tumors, and sarcoma. Primary outcomes, overall survival, and recurrence rates post-PM were assessed using random-effect models to account for study heterogeneity. Results: This study included 16 systematic-review articles and 101 individual studies, involving 10,277 patients who underwent PM for non-primary lung cancer. Patients had a mean age of 48.0 years, with 68.4% being male. About half of the patients(47.1% [95%CI 40.8-53.5] presented with multiple metastatic lesions, and complete R0 resection achieved in 87.2% [95%CI 83.0-90.8]. The pooled 5-year overall survival (OS) rate post-PM was 41.2% [95%CI, 37.1-45.4%]. Patients with germ cell tumors demonstrated significantly higher survival rate than other cancers(p<0.05), while patients with melanoma exhibited the poorest outcome(p<0.05). During follow-up, 57.6%[95%CI 46.4-68.1] had recurrence; 48% of them had intrathoracic-only recurrence and 52% had extra-thoracic recurrence. Conclusion: This study underscores the survival benefits associated with PM. Overall survival rates following PM do not significantly differ based on primary cancer types, except for germ cell tumors and melanoma. These findings highlight the importance of recognizing and incorporating PM into clinical practice when appropriate.

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The Role of Pulmonary Metastasectomy for Non‐Primary Lung Cancer: Umbrella Review of Meta‐Analyses

Woo,

Park,

Ahadi

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesDue to heterogeneous characteristics of primary cancers, the efficacy of pulmonary metastasectomy (PM) in nonprimary lung cancers has not been investigated. This study aims to investigate the clinical outcomes of PM for non‐primary lung cancer.MethodsA systematic search for meta‐analyses on PM for nonprimary lung cancers was conducted, encompassing publications up to January 3, 2024. This included seven primary cancers: renal cell, breast, adrenocortical, head and neck cancers, melanoma, germ cell tumors, and sarcoma. Overall survival and recurrence rates post‐PM were assessed using random‐effect models.ResultsThis study included 16 systematic‐review articles and 101 individual studies, involving 10 277 patients who underwent PM for nonprimary lung cancer. About half of the patients (47.1%) presented with multiple metastasis, and complete resection achieved in 87.2% [95% CI: 83.0–90.8]. The pooled 5‐year overall survival rate post‐PM was 41.2% [95%CI: 37.1%–45.4%]. Patients with germ cell tumors demonstrated higher survival rate (p < 0.05), while melanoma exhibited the worst outcome (p < 0.05). During follow‐up, 57.6% [95% CI: 46.4–68.1] had recurrence; 48% of them had intrathoracic‐only recurrence.ConclusionThis study underscores the survival benefits associated with PM. Overall survival rates following PM did not differ based on primary cancer types. These findings highlight the importance of recognizing and incorporating PM into clinical practice when appropriate.

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Survival Outcomes After Double-Lung Transplantation for Refractory Lung-Limited Cancers and Incidence of Post-Transplant Lung Cancer

Cited by 4 publications

References 26 publications

Rethinking the Impact of Pretransplant Malignancy (Pre-TM) on Double Lung Transplantation (DLT) Eligibility: An Analysis of 23,291 DLT Recipients

Rethinking the Impact of Pretransplant Malignancy (Pre-TM) on Double Lung Transplantation (DLT) Eligibility: An Analysis of 23,291 DLT Recipients

The role of pulmonary metastasectomy (PM) for non-primary lung cancer: Umbrella review of meta-analyses

The Role of Pulmonary Metastasectomy for Non‐Primary Lung Cancer: Umbrella Review of Meta‐Analyses

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