High frequency of bronchogenic carcinoma after single-lung transplantation
ABSTRACT Lung transplantation is a commonly employed therapy in the treatment of patients with advanced lung diseases related to tobacco use. Little is known about the long-term incidence or risk factors for primary lung cancer after lung transplantation. To determine the frequency, clinical features and risk factors for primary bronchogenic malignancy after lung transplantation, we designed a matched cohort study of single and bilateral lung transplant recipients with extended follow-up.
We retrospectively reviewed the records of 262 lung transplant recipients who survived > or =90 days post-transplant and assessed for the development of primary lung cancer. One hundred thirty-one consecutive single-lung transplant (SLTx) recipients were matched to 131 consecutive bilateral lung transplant (BLTx) recipients by native disease. Risk factors for lung cancer development were derived using univariate and multivariate proportional hazards models.
Of the SLTx recipients, 6.9% developed primary lung cancer after transplantation as compared with 0% of the BLTx recipients (p = 0.002), after a mean of 52 months. Histologically, non-small-cell cancers were present in the native lung, which led to death in 67% (6 of 9) of the patients despite treatment. Significant risk factors for the development of primary lung cancer were increasing age (p = 0.004), >60-pack-year smoking history (p = 0.03), and SLTx as compared with BLTx (p < 0.001).
Single-lung transplant confers a significantly elevated risk of developing primary post-transplant lung cancer as compared with BLTx in patients with comparable native disease, age and tobacco history.
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ABSTRACT: Risk factors for lung cancer in lung transplant recipients are a history of smoking and immunosuppression, to which adds increasing use of lungs from donors with a smoking history. The three typical presentations are incidental diagnosis on the explanted lung, concerning less than 2%; lung cancer developing on the lung graft, accounting for less than 1%; and incidence of lung cancer on the native lung, estimated at 9%. Treatment along available guidelines may be hampered by decreased lung function owing to chronic rejection or adverse effects of immunosuppression. Prognosis is comparable to a general population in resected stage I cancer and is less favorable in advanced stages.The Annals of Thoracic Surgery 05/2014; 98(1). DOI:10.1016/j.athoracsur.2014.04.014 · 3.63 Impact Factor
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ABSTRACT: The incidence of lung cancer is reputed to be higher and prognosis worse in solid organ transplant recipients than in the general population. Our purpose was to review the results of surgery in this group of patients.Revue de Pneumologie Clinique 08/2014; · 0.19 Impact Factor
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ABSTRACT: Background The incidence of lung cancer is reputed to be higher and prognosis worse in solid organ transplant recipients than in the general population. Our purpose was to review the results of surgery in this group of patients. Methods We retrospectively reviewed 49 male and 6 female patients; mean aged 60.6 years (38–85). Transplanted organ was heart (n = 37), kidney (n = 12), liver (n = 5) and both-lungs (n = 1); 48 patients had smoking habits and 42 heavy comorbidities (76.4%). Lung cancer was diagnosed during surveillance (78.2%, n = 43) or because of symptoms (21.8%, n = 12). We reviewed TNM and other main characteristics, among them histology (squamous-cell-carcinoma n= 23, adenocarcinomas n = 24, others n = 8). Results Surgery consisted of: exploratory thoracotomy (n = 2), wedge resections (n = 6), segmentectomy (n = 1), lobectomy (n = 42), pneumonectomy (n = 4). Postoperative mortality was 7.4% (n = 4) and complication rate 34.5% (n = 19). Five-year survival rate was 46.4% (65.4% for stage I patients, n = 25). Among the 35 dead patients during follow-up, 14 died of their lung cancer (40%). Two had been re-operated from another lung cancer: one after 3 and 8 years who survived 16 years, and the other after 2 years who survived 70 months. Conclusions Surgery results are good and postoperative events acceptable despite theoretically increased risks. This also supports performing a close follow-up of transplanted patients and particularly those with smoking history in view of detecting lung cancer appearing at an early stage.Revue de Pneumologie Clinique 12/2014; DOI:10.1016/j.pneumo.2014.04.007 · 0.19 Impact Factor