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Survival after cancer diagnosis among solid organ transplant recipients in the United States
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January 09 2019
Source: Cancer. 125(6):933-942
Details:
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Alternative Title:Cancer
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Personal Author:
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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.
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Pubmed ID:30624768
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Pubmed Central ID:PMC6403005
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