title: Immunosuppression and Multiple Primary Malignancies in Kidney-Transplanted Patients: A Single-Institute Study.
abstract: Immunodeficiency is associated with higher cancer incidence. However, it is unknown whether there is a link between immunodeficiency and development of multiple primary malignancies. In the present study we analyse this link focusing on kidney-transplanted patients, as they are at higher risk of developing cancer due to the chronic assumption of immunosuppressants. We followed up 1200 patients who underwent kidney transplantation between 1980 and 2012. A total of 77/1200 kidney-transplanted patients developed cancer and 24 of them developed multiple cancers. Most multiple cancers were synchronous with a nonsignificant association between cancer and rejection episodes. In the general cancer population, one-ninth of patients are at higher risk of developing a second tumor over a lifetime; hence it would be reasonable to conclude that, from a merely theoretical and statistical viewpoint, long-term transplanted patients potentially have a higher risk of developing MPMs. However, data did not confirm this assumption, probably because these patients die before a second primary malignancy appears. Despite many observations on the increased incidence of different tumor types in immunodeficient patients and despite immunosuppression certainly being a predisposing factor for the multicancer syndrome, data so far are not robust enough to justify a correlation between immunodeficiency and multiple primary malignancies in transplanted patients.
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Santangelo
authors.affiliation: Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: Criscitiello
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Renda
authors.affiliation: Department of Public Medicine, Operative Unit of Nephrology, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Federico
authors.affiliation: Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, 20141 Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Curigliano
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Dodaro
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scotti
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tammaro
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Armando
authors.initials: A
authors.lastname: Calogero
authors.affiliation: Department of Public Medicine, Operative Unit of Nephrology, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Riccio
authors.affiliation: Department of Public Medicine, Operative Unit of Nephrology, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pisani
authors.affiliation: Department of Advanced BioMedical Sciences, Operative Unit of General Surgery & Transplants, University of Naples Federico II, 80131 Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Carlomagno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015984:Causality; D015897:Comorbidity; D005260:Female; D006082:Graft Enhancement, Immunologic / Q000706:statistics & numerical data; D006084:Graft Rejection / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000139:chemically induced / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents