title: Incidental diagnosis of gastric cancer in transplant recipients improves patient survival.
abstract: BACKGROUND
  Gastric cancer in the United States is often diagnosed at advanced stages, resulting in dismal outcomes. In the immunosuppressed transplant recipient population, little is known about the clinical staging and outcome of these compromised patients.
  
  
  METHODS
  All US cases reported to the Israel Penn International Transplant Tumor Registry were retrospectively examined for patient demographics, immunosuppressive therapy, tumor characteristics, therapeutic modalities, and mortality. Statistical analysis was performed with Students t test, chi-square analysis, and log-rank analysis by the method of Kaplan-Meier.
  
  
  RESULTS
  Gastric cancer was identified in 34 recipients: 28 (82%) were male; 24 (71%) were white. Mean age at diagnosis was 58 +/- 11 years. Twenty-four (71%) patients received kidney transplants, 7 (21%) received heart transplants, and 3 (9%) received liver transplants. Fifty percent received induction therapy, whereas 94% were maintained on calcineurin inhibitors and corticosteroids. Thirty-five percent of patients were diagnosed during evaluation for gastrointestinal symptoms, with the remaining cases discovered incidentally during endoscopy (53%) or during computed tomography (12%) performed for other reasons. Stage varied at presentation as follows: stage I (n = 6), stage II (n = 11), stage III (n = 13), and stage IV (n = 4). Incidental diagnoses resulted in a lower stage malignancy (P <.001) and greater 1-year and 5-year survivals (P <.05) compared with those patients whose were diagnosed after being evaluated of gastrointestinal symptoms.
  
  
  CONCLUSIONS
  In the United States, because gastric cancer in the transplant recipient is frequently identified at an earlier stage (50% were stages I and II) than in the general population, survivals are equivalent despite continued administration of immunosuppression. This early identification may be attributed to more frequent presymptom diagnosis and staging, resulting from incidental detection of these malignancies during posttransplant upper endoscopy or computed tomography. Early detection has resulted in a 29% 5-year survival for the entire transplant recipient group compared with a 5% to 15% 5-year survival in the general population.
authors.affiliation: Israel Penn International Transplant Registry, The University of Cincinnati, Cincinnati, Ohio 45267-0558, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
authors.forename: Thomas
authors.initials: T
authors.lastname: Husted
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hanaway
authors.forename: V Ram
authors.initials: VR
authors.lastname: Peddi
authors.forename: Jennifer
authors.initials: J
authors.lastname: Trofe
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gross
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Beebe
authors.forename: M Roy
authors.initials: MR
authors.lastname: First
authors.forename: E Steve
authors.initials: ES
authors.lastname: Woodle
mesh_terms: D015897:Comorbidity; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008875:Middle Aged; D016377:Organ Transplantation; D044469:Racial Groups; D012042:Registries; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D007166:Immunosuppressive Agents