[Bronchogenic carcinoma in patients undergoing solid organ transplant. The role of surgery].
BACKGROUND
The incidence of neoplastic diseases is higher in patients undergoing solid organ transplant. However, the incidence of bronchogenic carcinoma (BC) is controversial. The objective of our study was to determine the incidence of BC in a large cohort of transplant patients and the role of surgery.


METHODS
Until December 2006, 3596 patients underwent solid organ transplant at our institution; 24 (0.7%) patients subsequently developed BC, of which 6 (24%) were classified as clinical stage I and submitted to surgical treatment. Survival was estimated by the Kaplan-Meier method.


RESULTS
Three patients received a liver transplant, two a kidney transplant and one a heart transplant. All were male and all had a smoking history. Mean age was 58.6 years. Two patients had cough, one accompanied by bloody expectoration, and BC was an incidental finding in the remaining cases. The interval between transplant and diagnosis of BC was 38.1 months. Epidermoid carcinoma was the most frequent histological type. Mean tumour size was 3.6cm (range, 1.3-6). One tumour was classified as pathological stage IA, four as stage IB and one as IIB due to parietal pleural invasion. No patient died during the perioperative period and only one had a haemothorax which resolved with chest tube drainage. Mean hospital stay was 8.5 days (range, 7-11). The immunosuppression regimen was maintained continuously. In subsequent follow-up, one patient died from BC metastasis, one from sepsis, one from chronic renal failure, and three remained alive. The probability of survival at 5 years was 40%, and median survival was established at 5 years.


CONCLUSIONS
The incidence of BC in patients undergoing solid organ transplant and the proportion of patients diagnosed in early stages does not differ from non-transplant patients diagnosed with BC, which questions the role of immunosuppression in the genesis and aggressiveness of BC in transplant patients. Surgery may offer acceptable results in early stages, with acceptable rates of perioperative morbidity and mortality.
Padilla
José
J
Servicio de Cirugía Torácica, Instituto Valenciano de Oncología, Valencia, España. jpadilla@comv.es
Cerón
José
J
Peñalver
Juan Carlos
JC
Jordá
Carlos
C
Pastor
Enrique
E
de Aguiar
Karol
K
D000368:Aged; D002283:Carcinoma, Bronchogenic / Q000453:epidemiology* / Q000209:etiology; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology