Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
J Comput Assist Tomogr. 2023;47(4):590-597. doi: 10.1097/RCT.0000000000001466. Epub 2023 Mar 9.
This study aimed to investigate clinical and radiologic characteristics of lung cancer in lung transplant recipients and evaluate the treatment course and prognosis.
The study included 448 patients who underwent lung transplant between 2005 and 2021. All patients had pretransplant chest computed tomography (CT), 429 patients had posttransplant CT, whereas 19 had no posttransplant CT (median number of posttransplant CT, 6; range, 0-24). Medical records of these patients were reviewed to identify patients who developed lung cancer after lung transplant. Computed tomography and positron emission tomography/CT at the time of lung cancer diagnoses were reviewed to obtain imaging features. Demographics, tumor histology, stages, and survival were compared using Fisher exact test and Wilcoxon rank sum test.
Among 448 lung transplant recipients with a median follow-up of 71.3 months after lung transplant, 15 patients (3.3%) developed posttransplant lung cancer (13 unilateral, 2 bilateral; 10 men, 5 women; median age, 63.1 years; median time from transplantation to cancer diagnosis, 3.1 years). Twelve cancers were in native lung, and 3 were in transplanted lung. The incidence of lung cancer was higher in single lung transplant recipients than in bilateral lung transplant recipients (10.3% vs 0.6%, respectively; P < 0.0001). Imaging manifestations varied according to tumor stages. Among 12 patients treated for lung cancer, 2 patients developed posttreatment acute respiratory distress syndrome. The median survival from cancer diagnosis of cancer was 6.2 months.
Posttransplant lung cancer was noted in 3% of lung transplant recipients and was more common in unilateral transplant recipients. The prognosis upon diagnosis was poor with rapid clinical deterioration and serious posttreatment complications.
本研究旨在探讨肺移植受者肺癌的临床和影像学特征，并评估其治疗过程和预后。
本研究纳入了 2005 年至 2021 年间接受肺移植的 448 例患者。所有患者在移植前均行胸部计算机断层扫描（CT）检查，429 例患者在移植后行 CT 检查，19 例患者无移植后 CT 检查（移植后 CT 中位数为 6 次；范围 0-24 次）。回顾这些患者的病历，以确定在肺移植后发生肺癌的患者。回顾肺癌诊断时的 CT 和正电子发射断层扫描/CT，以获得影像学特征。使用 Fisher 确切检验和 Wilcoxon 秩和检验比较人口统计学、肿瘤组织学、分期和生存情况。
在 448 例肺移植受者中，中位随访时间为肺移植后 71.3 个月，有 15 例（3.3%）发生移植后肺癌（13 例单侧，2 例双侧；10 例男性，5 例女性；中位年龄为 63.1 岁；从移植到癌症诊断的中位时间为 3.1 年）。12 例癌症位于原生肺，3 例位于移植肺。单肺移植受者的肺癌发生率高于双肺移植受者（10.3%比 0.6%；P < 0.0001）。影像学表现根据肿瘤分期而有所不同。在接受肺癌治疗的 12 例患者中，有 2 例患者发生治疗后急性呼吸窘迫综合征。从癌症诊断到癌症死亡的中位生存时间为 6.2 个月。
在 3%的肺移植受者中发现了移植后肺癌，在单侧移植受者中更为常见。诊断时的预后较差，临床恶化迅速，治疗后并发症严重。
