Survival after a cancer diagnosis among solid organ transplant recipients in the United States
Year: 2019
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis. METHODS: The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage. RESULTS: For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall. CONCLUSIONS: For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.
Source: Cancer
DOI: 10.1002/cncr.31782
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,200
Funders: Fred Hutchinson Cancer Research Center, University of Utah, Minneapolis Medical Research Foundation, National Institutes of Health, Centers for Disease Control and Prevention, Health Resources and Services Administration, National Cancer Institute, National Center for Chronic Disease Prevention and Health Promotion
Awards: Surveillance, Epidemiology and End Results (SEER) Program - Iowa, G1094858140, G1395498626, G1472229785, G1932976417, G2112066787, G2238803135, #14: Residual Tissue Repository to Create HIV Cancer Tumor Tissue Microrarrays , SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS (SEER) PROGRAM., G2594571626, G2875564675, G2925750098, G2970228389, G311352318, G3161224617, G3205575695, G3423876156, G3485696153, G3651850380, NATIONAL CANCER PREVENTION & CONTROL PROGRAM - ILLINOIS, G3725490100, G3857949968, G391480630, WS No. 12 Patterns of Care DX Year 2008, G413360666, G4467426518, G49039603, G4930587942, G5132823645, CALIFORNIA'S PARTICIPATION IN THE NATIONAL CANCER PREVENTION AND CONTRO PROGRAM, G5333917095, G5614148151, G5760116466, G5783477249, NATIONAL CANCER PREVENTION AND CONTROL PROGRAM, G63565440, G6374948078, G6428689724, G6585519052, G667355291, G6880417919, G702041046, G7032819450, G7278087418, G747710681, G7704819692, G7772923945, G8054769457, G8550955980, MICHIGAN CANCER PREVENTION & CONTROL PROGRAM, G867096425, NEW YORK STATE CANCER PREVENTION & CONTROL PROGRAM
OpenAlex ID: W2909217232