Risk Factors for De Novo Malignancy Following Lung Transplantation.
Risk factors for non-skin cancer de novo malignancy (DNM) after lung transplantation have yet to be identified. We queried the United Network for Organ Sharing database for all adult lung transplant patients between 1989 and 2012. Standardized incidence ratios (SIRs) were computed by comparing the data to Surveillance, Epidemiology, and End Results Program data after excluding skin squamous/basal cell carcinomas. We identified 18 093 adult lung transplant patients; median follow-up time was 1086 days (interquartile range 436-2070). DNMs occurred in 1306 patients, with incidences of 1.4%, 4.6%, and 7.9% at 1, 3, and 5 years, respectively. The overall cancer incidence was elevated compared with that of the general US population (SIR 3.26, 95% confidence interval [CI]: 2.95-3.60). The most common cancer types were lung cancer (26.2% of all malignancies, SIR 6.49, 95% CI: 5.04-8.45) and lymphoproliferative disease (20.0%, SIR 14.14, 95% CI: 9.45-22.04). Predictors of DNM following lung transplantation were age (hazard ratio [HR] 1.03, 95% CI: 1.02-1.05, p < 0.001), male gender (HR 1.20, 95% CI: 1.02-1.42, p = 0.03), disease etiology (not cystic fibrosis, idiopathic pulmonary fibrosis or interstitial lung disease, HR 0.59, 95% CI 0.37-0.97, p = 0.04) and single-lung transplantation (HR 1.64, 95% CI: 1.34-2.01, p < 0.001). Significant interactions between donor or recipient smoking and single-lung transplantation were noted. On multivariable survival analysis, DNMs were associated with an increased risk of mortality (HR 1.44, 95% CI: 1.10-1.88, p = 0.009).
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
J T
JT
Magruder
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
T C
TC
Crawford
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
J C
JC
Grimm
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
B
B
Kim
Department of Cardiac Surgery, Vanderbilt University School of Medicine, Nashville, TN.
A S
AS
Shah
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
E L
EL
Bush
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
R S
RS
Higgins
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
C A
CA
Merlo
D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology* / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012878:Skin Neoplasms / Q000209:etiology* / Q000473:pathology; D015996:Survival Rate
cancer/malignancy/neoplasia; cancer/malignancy/neoplasia: registry/incidence; cancer/malignancy/neoplasia: risk factors; clinical research/practice; health services and outcomes research; lung transplantation/pulmonology