1. Analysis of Non-cutaneous Cancer after Lung Transplantation
Brad A Broussard, MD,1 Vincent G Valentine, MD,1 Shawn P Nishi, MD,1 Scott D Lick, MD,2
Gisele A Lombard, BSN,1 Stephanie G LaPlace, BSN,3 Leonardo Seoane, MD,3 Reinaldo Rampolla, MD.3
1Lung Transplantation, UTMB Health, Galveston, TX;
2Cardiothoracic Surgery, UTMB Health, Galveston, TX; 3Lung Transplantation, Ochsner Medical Center, New Orleans, LA
PURPOSE
RESULTS
As follow-up lengthens and survival improves in lung transplantation (LT), the rate and threat of noncutaneous cancer (NCCa) loom large. To better clarify what lies ahead, this study describes the rates, types and potential risk factors of NCCa after LT.
Table 2. Cox proportional hazards models with early lymphomas (< 1 year) and bronchoalveolar cancer (BAC) recurrences removed are shown.
Figure 1. Types of non-cutaneous cancers
METHODS
Of 268 patients transplanted from 11/90-11/10, 23 (8.6%) cases of NCCa were identified in a combined database from 2 centers. Subjects were grouped by: age < or > 50; diagnosis, CF or nonCF; transplant type, single-lung (SLT) or not; and pre-transplant smoking history, >10-p-yr or not.
Figure 2. Comparison of cumulative incidences of NCCa in > 10-p-yr smokers vs < 10-p-yr
All lung cancers developed in SLT recipients at median (range), 4.7 (0.5–13.7) postoperative years. All but one of the bronchogenic carcinomas (squamous cell, n= 5) and adeno-, n=2) occurred in the native lung. Both BACs recurred in the allograft at post-op year 0.5 and 5.4.
Two patients diagnosed with breast cancer 3.7 and 7.9 years post LT were >10-p-yr smokers prior to transplant, had undergone BLT for emphysema and died of malignant progression, 4.7 and 5.5 years, after their cancer diagnosis, respectively.
The 1-, 3-, and 5-yr survival after NCCa diagnosis is 65%, 44%, and 17%, respectively.
Table 1. Details of transplant population
CONCLUSION
De novo NCCa threatens the lives of LT survivors and is independently associated with smoking before LT.