Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
Scientific Registry of Transplant Recipients, Minneapolis, MN.
J Clin Oncol. 2021 Dec 20;39(36):4039-4048. doi: 10.1200/JCO.21.01195. Epub 2021 Oct 22.
A previous cancer diagnosis is a negative consideration in evaluating patients for possible solid organ transplantation. Statistical models may improve selection of patients with cancer evaluated for transplantation.
We fitted statistical cure models for patients with cancer in the US general population using data from 13 cancer registries. Patients subsequently undergoing solid organ transplantation were identified through the Scientific Registry of Transplant Recipients. We estimated cure probabilities at diagnosis (for all patients with cancer) and transplantation (transplanted patients). We used Cox regression to assess associations of cure probability at transplantation with subsequent cancer-specific mortality.
Among 10,524,326 patients with 17 cancer types in the general population, the median cure probability at diagnosis was 62%. Of these patients, 5,425 (0.05%) subsequently underwent solid organ transplantation and their median cure probability at transplantation was 94% (interquartile range, 86%-98%). Compared with the tertile of transplanted patients with highest cure probability, those in the lowest tertile more frequently had lung or breast cancers and less frequently colorectal, testicular, or thyroid cancers; more frequently had advanced-stage cancer; were older (median 57 51 years); and were transplanted sooner after cancer diagnosis (median 3.6 8.6 years). Patients in the low-cure probability tertile had increased cancer-specific mortality after transplantation (adjusted hazard ratio, 2.08; 95% CI, 1.48 to 2.93; the high tertile), whereas those in the middle tertile did not differ.
Patients with cancer who underwent solid organ transplantation exhibited high cure probabilities, reflecting selection on the basis of existing guidelines and clinical judgment. Nonetheless, there was a range of cure probabilities among transplanted patients and low probability predicted increased cancer-specific mortality after transplantation. Cure probabilities may facilitate guideline development and evaluating individual patients for transplantation.
在评估可能接受实体器官移植的患者时，既往癌症诊断是一个不利因素。统计模型可能会改善对接受移植评估的癌症患者的选择。
我们使用来自 13 个癌症登记处的数据，为美国普通人群中的癌症患者拟合了统计治愈模型。随后通过移植受者科学登记处确定接受实体器官移植的患者。我们估计了所有癌症患者的诊断时（所有癌症患者）和移植时（移植患者）的治愈概率。我们使用 Cox 回归评估移植时的治愈概率与随后的癌症特异性死亡率之间的关联。
在普通人群中 17 种癌症类型的 10524326 例患者中，诊断时的中位治愈概率为 62%。这些患者中，5425 例（0.05%）随后接受了实体器官移植，其移植时的中位治愈概率为 94%（四分位距，86%-98%）。与治愈概率最高的三分之一移植患者相比，治愈概率最低的三分之一患者更常患有肺癌或乳腺癌，而较少患有结直肠癌、睾丸癌或甲状腺癌；更常患有晚期癌症；年龄更大（中位数 57 岁，51 岁）；并且在癌症诊断后更早接受移植（中位数 3.6 年，8.6 年）。移植后低治愈概率患者的癌症特异性死亡率增加（调整后的危险比，2.08；95%CI，1.48 至 2.93；高 tertile），而中 tertile 患者则无差异。
接受实体器官移植的癌症患者表现出较高的治愈概率，这反映了基于现有指南和临床判断的选择。尽管如此，移植患者的治愈概率存在一定范围，低概率预示着移植后癌症特异性死亡率增加。治愈概率可能有助于指南的制定和评估个体患者的移植。
