Characteristics of thoracic malignancies that occur after solid-organ transplantation

Our plain-English summary of Characteristics of thoracic malignancies that occur after solid-organ transplantation, by C. Génébès, L. Brouchet, N. Kamar, et al (Journal of Thoracic Oncology, 2010).

The study

• Authors: C. Génébès, L. Brouchet, N. Kamar, B. Lepage, G. Prévot, L. Rostaing, A. Didier, J. Mazières
• Journal: Journal of Thoracic Oncology
• Published: 2010;5(11):1789-95
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Chronic immunosuppression after solid-organ transplantation is associated with increased risk of developing malignancies. The purpose of this study was to determine the clinical characteristics and the outcome of thoracic malignancies in patients who have undergone solid-organ transplantation.

Methods: Among a cohort of 2831 patients who received a transplant at our institution and were followed between 1984 and 2009, 24 patients (0.85%) developed thoracic malignancies. Risk factors for lung cancer, as well as demographic, cancer, and transplantation characteristics, were analyzed. Survival data were also collected.

Results: Twenty-four patients were included (21 men, median age 61.7 years). Twenty-two patients were smokers. The most frequent histologic types were squamous cell carcinoma (n = 11, 46%) and adenocarcinoma (n = 9, 37%). The median time period between transplantation and diagnosis of lung cancer was 6.6 years. Ten lung malignancies occurred after kidney transplantation (0.5%), eight after liver transplantation (1.3%), and six after heart transplantation (2.8%). Seven patients underwent surgery, three had radiotherapy, four had chemotherapy, and six had multimodal treatment. The median survival time was 1.5 years, ranging from 6 months for stage IV to 3.7 years for stage I.

Conclusion: Solid-organ transplantation is associated with a high risk of lung cancer and may have an important synergetic part with other risk factors for lung cancer (tobacco). However, survival rates from lung cancer in our study population are similar to those of nontransplanted patients. In addition, surgery can result in favorable survival results.

In plain English

This retrospective cohort study, from hospitals in Toulouse, France, looked at chest cancers diagnosed in people who had received a solid-organ transplant. Of 2831 patients who received a transplant at the institution between February 1984 and May 2009, 24 (0.85%) later developed a thoracic malignancy. These were 10 of 1993 kidney recipients (0.5%), 8 of 599 liver recipients (1.3%) and 6 of 212 heart recipients (2.8%); none of the 27 lung recipients developed one. Twenty-two of the 24 were smokers. The authors recorded workplace exposure to carcinogens such as asbestos or chromium, but this information was missing for 20 of the 24 patients. The most common cancers were squamous cell carcinoma (11 patients) and adenocarcinoma (9); one patient had mesothelioma. Most cancers were advanced at diagnosis. Among the 23 patients in the survival analysis, median survival was 1.5 years and 5-year survival was 24%. The authors concluded that lung cancer can be an expected complication of transplantation and that survival was no worse than for non-transplant patients. They noted that their small numbers did not allow a definitive conclusion.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective cohort study combining a hospital lung cancer database and an organ transplant database
• Who was studied: 2831 patients who received a transplant at the Toulouse institution from February 1984 to May 2009 (1993 kidney, 599 liver, 212 heart, 27 lung). Of these, 24 patients (21 men, 3 women; median age at diagnosis 61.7 years) were diagnosed with a thoracic malignancy after transplantation.
• Exposure: Solid-organ transplantation (kidney, liver, heart) with long-term immunosuppressive treatment. Smoking history and workplace exposure to carcinogens such as asbestos or chromium were recorded as lung cancer risk factors. No asbestos fiber types or exposure levels were reported.
• Main results:
  • 24 of 2831 transplant recipients (0.85%) developed a thoracic malignancy.
  • The rate was 0.5% in kidney recipients, 1.3% in liver recipients and 2.8% in heart recipients. The authors reported that the difference between kidney and non-kidney (heart and liver) recipients was statistically significant (p value printed as 0.003; the comparison symbol is missing from the text).
  • For comparison, the authors cited a French national figure for men aged 60 in the 1990s of 207 cases per 100,000 inhabitants (0.27%).
  • 22 of the 24 patients were smokers. Two were nonsmokers, and both were kidney transplant recipients.
  • Workplace exposure to carcinogens was unknown for 20 of 24 patients. Table 1 lists 3 patients (12.5%) as exposed and 1 (4.2%) as not exposed.
  • Squamous cell carcinoma was the most common type (11 patients), followed by adenocarcinoma (9 patients).
  • One of the 24 patients (4.2%) had mesothelioma. Its site is not stated.
  • At diagnosis, 4 patients had stage I, 13 had stage III and 7 had stage IV cancer.
  • Among the 23 patients in the survival analysis, median survival was 1.5 years and 5-year survival was 24%.
  • Median survival was 3.7 years for stage I and 6 months for stage IV. The stage comparison had a log-rank p of 0.11.
  • Median survival was 7.3 years for liver recipients, 1.3 years for heart recipients and 0.7 years for kidney recipients (log-rank p = 0.03 in Table 6).
• The authors' conclusion: The authors concluded that lung cancer can be an expected complication of solid-organ transplantation, that survival from lung cancer in these patients is no worse than for non-transplant patients, and that cancer diagnosed early can offer good survival after surgery.
• Limitations the authors state:
  • The small study population does not allow a definitive conclusion about survival.
  • The small number of patients limited their ability to perform a multivariate analysis and to interpret the survival differences.
  • Workplace carcinogen exposure data were missing for most patients.
  • The small numbers did not allow conclusions about a possible protective effect of mTOR inhibitor drugs.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Squamous Cell Carcinoma, Adenocarcinoma, Chemotherapy, Median Survival.

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