Pulmonary and Lung Transplantation Division, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Creighton University School of Medicine- Phoenix Campus, Phoenix, Arizona, USA.
Prog Transplant. 2022 Dec;32(4):332-339. doi: 10.1177/15269248221122876. Epub 2022 Sep 7.
Incidentally detected malignancies in lung explants portend risk of early cancer recurrence and metastases with posttransplant immunosuppression. We present a series of lung transplant recipients with previously unverified malignancies in native lung explants. We reviewed the histopathology, radiographic imaging, and management of lung explant malignancies at our institution over 10 years (2011-2020). Endpoints were survival and allograft rejection. An explant malignancy was found in 1.3% (11/855) of lung transplant recipients (6 [55%] men; median age 68 years; 6 [55%] ex-smokers [median pack-years, 25]). Nine (82%) were adenocarcinoma, 1 (9%) was squamous cell carcinoma (SCC), and 1 (9%) was follicular lymphoma. Three patients (27%) had multifocal involvement (≥3 lobes), 4 (36%) had nodal involvement, and the median (range) tumor size was 2.7 (0.4-19) cm. The median interval between last imaging and transplant was 58 (29-144) days. Mycophenolate mofetil was discontinued or reduced in all; everolimus was used in 2 patients, and cisplatin-pemetrexed chemotherapy was used in 2 patients. The prevalence of acute cellular rejection and chronic rejection was 27% and 9%, respectively. Lung recipients with cancer had significantly lower survival than those without (36.4% vs 67.3%, p = 0.002); median survival was 27 (17, 65) months in 4 recipients who were alive and cancer-free at the end of the study period. Unidentified malignancies, commonly adenocarcinoma, can be detected in explanted native lungs. Pneumonectomy may be curative in SCC, lymphoproliferative disorders, and stage I adenocarcinoma. Modulating immunosuppression to prevent allograft rejection and tumor proliferation is warranted.
偶然在肺移植标本中发现的恶性肿瘤预示着在移植后免疫抑制后早期癌症复发和转移的风险。我们报告了一系列在肺移植前的肺标本中未确诊为恶性肿瘤的肺移植受者。我们回顾了 10 年来（2011-2020 年）我院肺移植标本中恶性肿瘤的组织病理学、影像学表现和治疗方法。终点是生存率和移植物排斥。在 855 例肺移植受者中发现 1.3%（11/855）存在移植标本恶性肿瘤（6 例[55%]为男性；中位年龄 68 岁；6 例[55%]为戒烟者[中位吸烟量 25]）。9 例（82%）为腺癌，1 例（9%）为鳞状细胞癌（SCC），1 例（9%）为滤泡性淋巴瘤。3 例（27%）存在多发病灶（≥3 个肺叶），4 例（36%）存在淋巴结受累，肿瘤大小中位数（范围）为 2.7（0.4-19）cm。末次影像学检查与移植之间的中位间隔时间为 58（29-144）天。所有患者均停用或减少了吗替麦考酚酯；2 例患者使用了依维莫司，2 例患者使用了顺铂-培美曲塞化疗。急性细胞排斥反应和慢性排斥反应的发生率分别为 27%和 9%。患有癌症的肺移植受者的生存率明显低于无癌症者（36.4%比 67.3%，p=0.002）；在研究结束时仍存活且无癌症的 4 例患者的中位生存时间为 27（17，65）个月。在移植前的肺标本中可以发现未识别的恶性肿瘤，通常为腺癌。SCC、淋巴增生性疾病和 I 期腺癌可行肺切除术治愈。有必要调节免疫抑制以预防移植物排斥和肿瘤增殖。
