Department of Surgery, Mayo Clinic Florida, 4500 San Pablo Boulevard, Jacksonville, FL 32224, United States.
Department of Cardiothoracic Surgery and Transplantation, Mayo Clinic Florida, 4500 San Pablo Boulevard, Jacksonville, FL 32224, United States.
Lung Cancer. 2013 Sep;81(3):451-454. doi: 10.1016/j.lungcan.2013.05.018. Epub 2013 Jul 5.
Lung cancer following lung transplantation is an infrequent occurrence of post-transplant neoplasia. Tumors are classified based on donor or recipient origin. Recipient tumors can be diagnosed in explanted specimens or found in contralateral native lungs which remain in place during single lung transplant (SLTx). The aim of our study was to review our institution's incidence of post lung transplant lung cancer, describe tumor histology, and review our experience with their outcomes.
A total of 335 lung transplants from 2001 to 2010 were reviewed. Patients were identified with a post-transplant diagnosis of lung cancer, neoplasia, or mass. Fifteen patients were identified; two were excluded due to concomitant cancers with which the lung cancer would represent a metastasis. Retrospective chart review was undertaken for thirteen patients for descriptive statistics, tumor characteristics and overall survival.
Overall incidence of lung cancer following transplant was 13 cases (3.88%). Six tumors were found in native explanted lungs and six developed subsequently in native lungs. One tumor was confirmed to be of donor origin. Histology included squamous cell in five (38.4%), adenocarcinoma in four (30.7%), and one patient each with adenosquamous (7.6%), carcinoid (7.6%), small cell (7.6%), or malignant solitary fibrous tumor (7.6%). Mean age at transplant was 65 ± 3 years. Mean time from transplant to diagnosis is reported as 241 ± 7 days (range 1-1170). Each patient had at least a 20 pack year smoking history with a mean of 45 ± 3 years. One-year survival for those with lung cancer following transplant was 42.8% while 1 year survival of all lung transplants at our institution is 85.7%.
Lung cancer incidentally found at the time of transplant or following transplantation is a serious complication with a noted effect on overall survival. The infrequent occurrence of donor tumors represents an adequate screening process of potential young donor lungs. The recognition of cancers in explanted specimens brings to question policies regarding screening of potential recipients with extensive smoking history. A high index of suspicion for native tumors is needed when conducting post-transplant surveillance as these tumors tend to be stage 4 at time diagnosis.
肺移植后发生肺癌是移植后肿瘤的一种罕见情况。肿瘤根据供体或受体来源进行分类。受体肿瘤可在移植肺标本中诊断，也可在单肺移植（SLTx）中保留的对侧原生肺中发现。我们研究的目的是回顾本机构肺移植后肺癌的发病率，描述肿瘤组织学，并回顾我们对其结果的经验。
回顾了 2001 年至 2010 年期间的 335 例肺移植。在移植后诊断为肺癌、肿瘤或肿块的患者中确定了患者。共确定了 15 例患者，由于与肺癌相比，肺癌为转移的合并癌，因此排除了其中的 2 例。对 13 例患者进行了回顾性图表回顾，以进行描述性统计、肿瘤特征和总生存分析。
移植后肺癌的总发生率为 13 例（3.88%）。在 6 例原生移植肺中发现肿瘤，在 6 例原生肺中随后发生肿瘤。1 例肿瘤确认为供体来源。组织学包括 5 例鳞状细胞癌（38.4%）、4 例腺癌（30.7%）、1 例腺鳞癌（7.6%）、1 例类癌（7.6%）、1 例小细胞癌（7.6%）或恶性孤立性纤维瘤（7.6%）。移植时的平均年龄为 65 ± 3 岁。从移植到诊断的平均时间报告为 241 ± 7 天（范围 1-1170）。每位患者都有至少 20 包年的吸烟史，平均为 45 ± 3 年。移植后患有肺癌的患者的 1 年生存率为 42.8%，而本机构所有肺移植的 1 年生存率为 85.7%。
在移植时或移植后偶然发现的肺癌是一种严重的并发症，对总生存率有明显影响。供体肿瘤的罕见发生代表了对潜在年轻供体肺的充分筛选过程。在移植肺标本中发现癌症提出了关于对有大量吸烟史的潜在受者进行广泛筛查的政策问题。在进行移植后监测时，需要对原生肿瘤保持高度怀疑，因为这些肿瘤在诊断时往往处于 4 期。
