Sigel Keith, Veluswamy Rajwanth, Krauskopf Katherine, Mehrotra Anita, Mhango Grace, Sigel Carlie, Wisnivesky Juan
1 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai New York, NY. 2 Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY. 3 Department of Pathology, Memorial Sloan-Kettering Hospital, New York, NY.
Transplantation. 2015 Oct;99(10):2181-9. doi: 10.1097/TP.0000000000000715.
Treatment-related immunosuppression in organ transplant recipients has been linked to increased incidence and risk of progression for several malignancies. Using a population-based cancer cohort, we evaluated whether organ transplantation was associated with worse prognosis in elderly patients with non-small cell lung cancer (NSCLC).
Using the Surveillance, Epidemiology, and End Results Registry linked to Medicare claims, we identified 597 patients aged 65 years or older with NSCLC who had received organ transplants (kidney, liver, heart, or lung) before cancer diagnosis. These cases were compared to 114,410 untransplanted NSCLC patients. We compared overall survival (OS) by transplant status using Kaplan-Meier methods and Cox regression. To account for an increased risk of non-lung cancer death (competing risks) in transplant recipients, we used conditional probability function (CPF) analyses. Multiple CPF regression was used to evaluate lung cancer prognosis in organ transplant recipients while adjusting for confounders.
Transplant recipients presented with earlier stage lung cancer (P = 0.002) and were more likely to have squamous cell carcinoma (P = 0.02). Cox regression analyses showed that having received a non-lung organ transplant was associated with poorer OS (P < 0.05), whereas lung transplantation was associated with no difference in prognosis. After accounting for competing risks of death using CPF regression, no differences in cancer-specific survival were noted between non-lung transplant recipients and nontransplant patients.
Non-lung solid organ transplant recipients who developed NSCLC had worse OS than nontransplant recipients due to competing risks of death. Lung cancer-specific survival analyses suggest that NSCLC tumor behavior may be similar in these 2 groups.
器官移植受者中与治疗相关的免疫抑制与多种恶性肿瘤的发病率增加及进展风险相关。我们利用基于人群的癌症队列，评估器官移植是否与老年非小细胞肺癌（NSCLC）患者的预后较差有关。
利用与医疗保险索赔相关联的监测、流行病学和最终结果登记处，我们确定了597例年龄在65岁及以上、在癌症诊断前接受过器官移植（肾、肝、心或肺）的NSCLC患者。将这些病例与114,410例未接受移植的NSCLC患者进行比较。我们使用Kaplan-Meier方法和Cox回归比较移植状态下的总生存期（OS）。为了考虑移植受者中非肺癌死亡（竞争风险）风险的增加，我们使用了条件概率函数（CPF）分析。在调整混杂因素的同时，使用多元CPF回归评估器官移植受者的肺癌预后。
移植受者的肺癌分期较早（P = 0.002），且更有可能患有鳞状细胞癌（P = 0.02）。Cox回归分析表明，接受非肺器官移植与较差的OS相关（P < 0.05），而肺移植与预后无差异。在使用CPF回归考虑死亡的竞争风险后，非肺移植受者与未移植患者之间在癌症特异性生存期方面未发现差异。
由于死亡的竞争风险，发生NSCLC的非肺实体器官移植受者的OS比未移植受者更差。肺癌特异性生存分析表明，这两组中NSCLC的肿瘤行为可能相似。
