Predicted Cure and Survival Among Transplant Recipients With a Previous Cancer Diagnosis

Abstract

PURPOSE A previous cancer diagnosis is a negative consideration in evaluating patients for possible solid organ transplantation. Statistical models may improve selection of patients with cancer evaluated for transplantation. METHODS We fitted statistical cure models for patients with cancer in the US general population using data from 13 cancer registries. Patients subsequently undergoing solid organ transplantation were identified through the Scientific Registry of Transplant Recipients. We estimated cure probabilities at diagnosis (for all patients with cancer) and transplantation (transplanted patients). We used Cox regression to assess associations of cure probability at transplantation with subsequent cancer-specific mortality. RESULTS Among 10,524,326 patients with 17 cancer types in the general population, the median cure probability at diagnosis was 62%. Of these patients, 5,425 (0.05%) subsequently underwent solid organ transplantation and their median cure probability at transplantation was 94% (interquartile range, 86%-98%). Compared with the tertile of transplanted patients with highest cure probability, those in the lowest tertile more frequently had lung or breast cancers and less frequently colorectal, testicular, or thyroid cancers; more frequently had advanced-stage cancer; were older (median 57 v 51 years); and were transplanted sooner after cancer diagnosis (median 3.6 v 8.6 years). Patients in the low-cure probability tertile had increased cancer-specific mortality after transplantation (adjusted hazard ratio, 2.08; 95% CI, 1.48 to 2.93; v the high tertile), whereas those in the middle tertile did not differ. CONCLUSION Patients with cancer who underwent solid organ transplantation exhibited high cure probabilities, reflecting selection on the basis of existing guidelines and clinical judgment. Nonetheless, there was a range of cure probabilities among transplanted patients and low probability predicted increased cancer-specific mortality after transplantation. Cure probabilities may facilitate guideline development and evaluating individual patients for transplantation.

Use of Systemic Therapies for Treatment of Psoriasis in Patients with a History of Treated Solid Tumours: Inference-Based Guidance from a Multidisciplinary Expert Panel

“…The nature of tumours developing in patients with SOT suggests the elevated risk is related to a decrease in immunologic control over oncogenic infections or reactivation of latent infections [48,52]. In general, pre-transplant malignancy is associated with an increased risk of all-cause mortality in transplant patients with SOT, and possibly cancer-specific mortality [50,54,[57][58][59][60][61][62]. This is likely due to end-stage organ disease and transplant-related complications, but is highly influenced by type of malignancy, grade/stage, tumour-specific characteristics, projected overall survival, time to transplant, and age [50,54,[57][58][59][60][61][62].…”

“…In general, pre-transplant malignancy is associated with an increased risk of all-cause mortality in transplant patients with SOT, and possibly cancer-specific mortality [50,54,[57][58][59][60][61][62]. This is likely due to end-stage organ disease and transplant-related complications, but is highly influenced by type of malignancy, grade/stage, tumour-specific characteristics, projected overall survival, time to transplant, and age [50,54,[57][58][59][60][61][62]. It is unclear if modified immunosuppressive regimens lead to increased all-cause mortality in transplant patients with SOT.…”

Prior cancer history and suitability for kidney transplantation

“…In this registry analyses of over 10 000 000 patients, 17 cancer types were assessed. At the time of transplant, the mean cure probability among transplanted patients with cancer was 94% and was considerably higher than that in patients with cancer in the general population [ 18 ]. Transplant recipients with low cure probabilities were more likely to have a previous diagnosis of oral cavity or pharyngeal, lung, breast, bladder or kidney cancers, or multiple myeloma.…”

“…Moreover, these cure probabilities may correlate with post-transplant cancer-specific mortality. The risk of cancer-related death doubled among recipients with cancers of low cure probabilities compared with those with high cure probability, but risk of non-cancer related death was not associated with the cure probabilities of cancer [ 18 ]. For recipients with a prior history of haematological malignancy such as multiple myeloma, treatments with chemotherapy and immunomodulating agents such as lenalidomide, or other proteasome inhibitors and monoclonal antibodies, may control the progression of disease, but these therapies are not curative [ 19 ].…”

A novel prognostic model for cervical cancer patients with lymph node metastases: based on SEER database and an independent cohort

“…For physicians, predicting the probability of survival for a certain cancer has increasingly recognized to change the pattern of medical practice and provide reference for individualized clinical decision making (13,14). A nomogram can be utilized to predict intuitively the onset or progression of a disease jointly by multiple indicators, which makes the prospect of predicting the probability of survival of a disease an increasing reality in recent years (15)(16)(17).…”