Long-term survival of heart transplant recipients with lung cancer: the role of chest computed tomography screening.
OBJECTIVE
We sought to evaluate the screening modality and outcome of lung cancer occurring in heart transplant recipients (HTR) during a 21-year period.


METHODS
We conducted a retrospective review to investigate the incidence, risk factors, screening modality, treatment, and outcomes in HTR with lung cancer. We compared them with a case-matched HTR control group.


RESULTS
Out of 829 recipients of heart transplants, 19 cases of bronchogenic carcinoma were found either by routine chest X-ray (n = 10), chest computed tomographic (CT) scanning (n = 4), or by assessment of clinical symptoms (n = 5). The mean time from transplantation to bronchogenic carcinoma diagnosis was 68.8 +/- 42.4 months. A history of smoking was the only risk factor in HTR with bronchogenic carcinoma compared to their case-matched HTR control group ( P < 0.05). Of 18 patients with non-small cell lung cancer (NSCLC), 13 underwent surgery and 5 with advanced cancer underwent chemotherapy and/or radiotherapy. NSCLC was diagnosed by chest X-ray (n = 10), and 6 of these patients died after an average of 43.7 +/- 62.2 months following cancer detection. NSCLC was also diagnosed on the basis of clinical symptoms (n = 4), and 2 of these patients died after a mean follow-up of 9 +/- 4.2 months after cancer diagnosis. All 4 patients in whom cancer was detected by CT scan were alive at an average of 53.5 +/- 36.7 months following cancer detection. The survival rates did not differ between the study and control groups ( P = 0.5).


CONCLUSIONS
Optimal outcomes of treatment for primary lung cancer after heart transplantation seem to be related to early detection. A high proportion of deaths from NSCLC may be prevented by chest CT scan screening.
Mohammadi
S
S
Department of Cardiothoracic Surgery, La Pitié Hospital, Paris, France. siamakmohammadi@yahoo.com
Bonnet
N
N
Leprince
P
P
Charbonneau
E
E
Berberian
G
G
Aslani
M
M
Silvaggio
G
G
Dorent
R
R
Pavie
A
A
Gandjbakhch
I
I
D000230:Adenocarcinoma / Q000000981:diagnostic imaging; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D002283:Carcinoma, Bronchogenic / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011013:Pneumonectomy; D011878:Radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D017741:Survivors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome