Grewal Amardeep S, Padera Robert F, Boukedes Steve, Divo Miguel, Rosas Ivan O, Camp Phillip C, Fuhlbrigge Anne, Goldberg Hilary, El-Chemaly Souheil
Harvard Medical School, Boston, MA 02115, USA.
Department of Pathology, Boston, MA 02115, USA.
Respir Med. 2015 Mar;109(3):427-33. doi: 10.1016/j.rmed.2014.12.013. Epub 2015 Jan 7.
Lung transplant is the only available therapy for patients with advanced lung disease. The goal of this study was to examine the prevalence, origin, management and outcome of lung cancer in recipients of lung transplant at our institution.
After institutional review board approval, we conducted a retrospective chart review of all lung transplantations in our institution from January 1990 until June 2012.
The prevalence of lung cancer in the explanted lung was 6 (1.2%) of 462 and all cases were in subjects with lung fibrosis. All 4 subjects with lymph node involvement died of causes related to the malignancy. Nine (1.9%) of 462 patients were found to have bronchogenic carcinoma after lung transplant. The most common location was in the native lung in recipients of a single lung transplant (6 out of 9 patients). In one case, the tumor originated in the allograft and was potentially donor related. The median time to diagnosis after lung transplant was 28 months with a range from 9 months to 10 years. Median survival was 8 months, with tumors involving lymph nodes or distant metastases associated with a markedly worse prognosis (median survival 7 months) than stage I disease (median survival 27 months).
The prevalence of lung cancer in lung transplant recipients is low. Using accepted donor screening criteria, donor derived malignancy is exceptionally rare. While stage I disease is associated with improved survival in this cohort, survival is still not comparable to that of the general population, likely influenced by the need for aggressive immune suppression.
肺移植是晚期肺部疾病患者唯一可行的治疗方法。本研究的目的是调查我院肺移植受者中肺癌的患病率、起源、管理及预后情况。
经机构审查委员会批准后，我们对1990年1月至2012年6月期间我院所有肺移植病例进行了回顾性病历审查。
切除的肺中肺癌的患病率为462例中的6例（1.2%），所有病例均发生在肺纤维化患者中。所有4例有淋巴结受累的患者均死于与恶性肿瘤相关的原因。462例患者中有9例（1.9%）在肺移植后被发现患有支气管源性癌。最常见的部位是单肺移植受者的原肺（9例患者中有6例）。在1例病例中，肿瘤起源于同种异体移植肺，可能与供体有关。肺移植后诊断的中位时间为28个月，范围为9个月至10年。中位生存期为8个月，有淋巴结受累或远处转移的肿瘤患者的预后明显比I期疾病（中位生存期27个月）差（中位生存期7个月）。
肺移植受者中肺癌的患病率较低。采用公认的供体筛查标准，供体源性恶性肿瘤极为罕见。虽然I期疾病在该队列中与生存率提高相关，但生存率仍无法与普通人群相比，这可能受到积极免疫抑制需求的影响。
