Survival after the diagnosis of de novo malignancy in liver transplant recipients

Abstract

In the setting of liver transplant (LT), the survival after the diagnosis of de novo malignancies (DNMs) has been poorly investigated. In this study, we assessed the impact of DNMs on survival of LT recipients as compared to corresponding LT recipients without DNM. A nested case-control study was conducted in a cohort of 2,818 LT recipients enrolled in nine Italian centres between 1985 and 2014. Cases were 244 LT recipients who developed DNMs after LT. For each case, two controls matched for gender, age, and year at transplant were selected by incidence density sampling among cohort members without DNM. The survival probabilities were estimated using the Kaplan-Meier method. Hazard ratios (HRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. The all-cancer 10-year survival was 43% in cases versus 70% in controls (HR = 4.66; 95% CI: 3.17-6.85). Survival was impaired in cases for all the most frequent cancer types, including lung (HR = 37.13; 95% CI: 4.98-276.74), non-Hodgkin lymphoma (HR = 6.57; 95% CI: 2.15-20.01), head and neck (HR = 4.65; 95% CI: 1.81-11.95), and colon-rectum (HR = 3.61; 95% CI: 1.08-12.07). The survival gap was observed for both early and late mortality, although the effect was more pronounced in the first year after cancer diagnosis. No significant differences in survival emerged for Kaposi's sarcoma and nonmelanoma skin cancers. The survival gap herein quantified included a broad range of malignancies following LT and prompts close monitoring during the post-transplant follow-up to ensure early cancer diagnosis and to improve survival.

Outcomes of head and neck surgery in patients with a history of solid organ transplantation

“…It is estimated that 50% of malignancies in transplant patients are in the head and neck region; however, the majority are cutaneous cancer, and only 4% to 6% are noncutaneous cancers . In a study from Italy that involved 2,818 liver transplant recipients, 244 identified subjects developed de novo malignancy, 15.5% of which were head and neck and thyroid gland cancers . Patients who developed head and neck cancer had a significantly lower survival .…”

“…3,5 In a study from Italy that involved 2,818 liver transplant recipients, 244 identified subjects developed de novo malignancy, 15.5% of which were head and neck and thyroid gland cancers. 15 Patients who developed head and neck cancer had a significantly lower survival. 15 Likewise, in a meta-analysis by Liu et al identified a 3.8-fold higher risk of head and neck cancer in liver transplant recipients compared to the general population.…”

“…15 Patients who developed head and neck cancer had a significantly lower survival. 15 Likewise, in a meta-analysis by Liu et al identified a 3.8-fold higher risk of head and neck cancer in liver transplant recipients compared to the general population. 16 In another meta-analysis, the risk of laryngeal cancer was found to be 2-fold higher in solid organ recipients compared to the general population.…”

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

“…The incidence of tumor recurrence was indeed much lower in the treated malignancy group than in the incidental malignancy group in the present study because patients in the treated malignancy group were naturally selected through long‐term observation after curative treatment. The risk of post‐transplant tumor recurrence in the treated malignancy group appears to be comparable to that of patients with post‐transplant de novo malignancy …”

Dissecting the Multiplicity of Immune Effects of Immunosuppressive Drugs to Better Predict the Risk of de novo Malignancies in Solid Organ Transplant Patients

“…A recent study demonstrated that the all-cancer 10-year survival in a large cohort of Italian liver transplant patients experiencing a malignancy was significantly lower as compared to that of liver transplant recipients without cancer (43 vs. 70%, HR = 4.66). The difference in survival was observed for both early and late mortality, although the effect was more pronounced in the first year after cancer diagnosis (188). These findings clearly point to the need to perform close oncologic monitoring during the post-transplant follow-up in order to ensure early cancer diagnosis and to improve survival.…”