Survival after cancer diagnosis among solid organ transplant recipients in the United States

Details

• Alternative Title:
  Cancer
• Personal Author:
  D’Arcy, Monica E. ; Coghill, Anna E. ; Lynch, Charles F. ; Koch, Lori ; Li, Jie ; Pawlish, Karen S. ; Morris, Cyllene R. ; Rao, Chandrika ; Engels, Eric A.
• Description:
  Purpose:
  
  Transplant recipients have an elevated risk of cancer because of organ rejection immunosuppressive medications, but no study has comprehensively examined associations between transplant status and mortality following a cancer diagnosis.
  
  Methods:
  
  For 16 different cancer types, we assessed cases in the US general population (N=7,147,476) ascertained from 11 cancer registries. Presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplant registry (1987–2014). We used Cox models to examine the association between transplant status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage.
  
  Results:
  
  For most cancers, cancer-specific mortality was higher in transplant recipients than for other cancer patients. The increase was particularly pronounced for melanoma (adjusted hazard ratio (aHR)=2.59, 95%CI 2.18–3.00) and cancers of the breast (1.88, 1.61–2.19), bladder (1.85, 1.58–2.17), and colorectum (1.77, 1.60–1.96), but it was also increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung, and diffuse large B-cell lymphoma (aHRs ranging from 1.21 to 1.47). Associations remained significant after adjustment for first-course cancer treatment and were generally stronger among local stage cancers for which potentially curative treatment was provided, e.g., for melanoma (aHR=3.82, 95%CI 2.94–4.97), and cancers of the colorectum (2.77, 2.07–3.70), breast (2.08, 1.50–2.88), and prostate (1.60, 1.12–2.29), despite lack of association for prostate cancer overall.
  
  Conclusion:
  
  For multiple cancer types, transplant recipients with cancer have an elevated risk of dying from their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Case-Control Studies Female Humans Male Middle Aged Neoplasms Organ Transplantation Proportional Hazards Models Registries Survival Analysis Transplant Recipients

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• Source:
  Cancer. 125(6):933-942
• Pubmed ID:
  30624768
• Pubmed Central ID:
  PMC6403005
• Document Type:
  Journal Article
• Funding:
  U58 DP003931/DP/NCCDPHP CDC HHS/United States ; HHSN261201000037C/CA/NCI NIH HHS/United States ; N01PC35143/CA/NCI NIH HHS/United States ; U58 DP003875/DP/NCCDPHP CDC HHS/United States ; N01PC35137/CA/NCI NIH HHS/United States ; HHSN261201300071C/CA/NCI NIH HHS/United States ; U58 DP003920/DP/NCCDPHP CDC HHS/United States ; U58 DP003933/DP/NCCDPHP CDC HHS/United States ; U58 DP000848/DP/NCCDPHP CDC HHS/United States ; HHSN261201300011I/CA/NCI NIH HHS/United States ; N01PC35139/CA/NCI NIH HHS/United States ; U58 DP000824/DP/NCCDPHP CDC HHS/United States ; HHSN261201300019C/CA/NCI NIH HHS/United States ; U58 DP003883/DP/NCCDPHP CDC HHS/United States ; HHSN261201000035C/CA/NCI NIH HHS/United States ; P30 CA086862/CA/NCI NIH HHS/United States ; HHSN261201000036C/CA/NCI NIH HHS/United States ; U58 DP003879/DP/NCCDPHP CDC HHS/United States ; HHSN261201300011C/RC/CCR NIH HHS/United States ; U58 DP000807/DP/NCCDPHP CDC HHS/United States ; N01PC35142/CA/NCI NIH HHS/United States ; Z99 CA999999/ImNIH/Intramural NIH HHS/United States ; HHSN261201300021C/CA/NCI NIH HHS/United States ; HHSN261201000035I/CA/NCI NIH HHS/United States ; HHSN261201000034C/CA/NCI NIH HHS/United States ; U58 DP003921/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  United States
• Volume:
  125
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:ff1ceaed4bd0867dda2f63ec19be73da13cb3092577992a5bed601e8b0bf06cf
• Download URL:
  https://stacks.cdc.gov/view/cdc/76375/cdc_76375_DS1.pdf
• File Type:
  [PDF - 122.11 KB ]