Long-term Survival of Heart Transplant Recipients with Lung Cancer: The Role of Chest Computed Tomography Screening

Abstract

Objective: We sought to evaluate the screening modality and outcome of lung cancer occurring in heart transplant recipients (HTR) during a 21-year period. Methods: We conducted a retrospective review to investigate the incidence, risk factors, screening modality, treatment, and outcomes in HTR with lung cancer. We compared them with a case-matched HTR control group. Results: Out of 829 recipients of heart transplants, 19 cases of bronchogenic carcinoma were found either by routine chest X‐ray (n = 10), chest computed tomographic (CT) scanning (n = 4), or by assessment of clinical symptoms (n = 5). The mean time from transplantation to bronchogenic carcinoma diagnosis was 68.8 ± 42.4 months. A history of smoking was the only risk factor in HTR with bronchogenic carcinoma compared to their case-matched HTR control group (p < 0.05). Of 18 patients with non-small cell lung cancer (NSCLC), 13 underwent surgery and 5 with advanced cancer underwent chemotherapy and/or radiotherapy. NSCLC was diagnosed by chest X-ray (n = 10), and 6 of these patients died after an average of 43.7 ± 62.2 months following cancer detection. NSCLC was also diagnosed on the basis of clinical symptoms (n = 4), and 2 of these patients died after a mean follow-up of 9 ± 4.2 months after cancer diagnosis. All 4 patients in whom cancer was detected by CT scan were alive at an average of 53.5 ± 36.7 months following cancer detection. The survival rates did not differ between the study and control groups (p = 0.5). Conclusions: Optimal outcomes of treatment for primary lung cancer after heart transplantation seem to be related to early detection. A high proportion of deaths from NSCLC may be prevented by chest CT scan screening.

Key words

heart and lung transplantation - cardiomyopathy - thoracic surgery

References

• 1 Taylor D O, Edwards L B, Boucek M M. et al . Registry of the International Society for Heart and Lung Transplantation: twenty-second official adult heart transplant report - 2005.  J Heart Lung Transplant. 2005;  24 945-955
• 2 Penn I. Incidence and treatment of neoplasia after transplantation.  J Heart Lung Transplant. 1993;  12 S328-S336
• 3 Dorent R, Mohammadi S, Tezenas S. et al . Lung cancer in heart transplant patients: a 16-year survey.  Transplant Proc. 2000;  32 2752-2754
• 4 Hill C, Doyon F. Frequency of cancer in France: 2004 update.  Bull Cancer. 2004;  91 9-14
• 5 Anyanwu A C, Townsend E R, Banner N R, Burke M, Khaghani A, Yacoub M H. Primary lung carcinoma after heart or lung transplantation: management and outcome.  J Thorac Cardiovasc Surg. 2002;  124 1190-1197
• 6 Bagan P, Assouad J, Berna P, Souilamas R, Le Pimpec Barthes F, Riquet M. Immediate and long-term survival after surgery for lung cancer in heart transplant recipients.  Ann Thorac Surg. 2005;  79 438-442
• 7 Potaris K, Radovancevic B, Thomas C D. et al . Lung cancer after heart transplantation: a 17-year experience.  Ann Thorac Surg. 2005;  79 980-983
• 8 Goldstien D J, Austin J H, Zuech N. et al . Carcinoma of the lung after heart transplantation.  Transplantation. 1996;  62 772-775
• 9 Pham S M, Kormos R L, Landreneau R J. et al . Solid tumor after heart transplantation: lethality of lung cancer.  Ann Thorac Surg. 1995;  60 1623-1626
• 10 Taniguchi S, Cooper D K, Chaffin J S, Zuhdi N. Primary bronchogenic carcinoma in recipients of heart transplantation.  Transpl Int. 1997;  10 312-316
• 11 Mohammadi S, Silvaggio G, Bonnet N. et al . Prostate cancer after heart transplantation: unicenter case-control study.  J Heart Lung Transplant. 2005;  24 995-997
• 12 Curtil A, Robin J, Tronc F. et al . Malignant neoplasms following cardiac transplantation.  Eur J Cardiothorac Surg. 1997;  12 101-106
• 13 Shiba N, Chan M C, Valentine H A, Gao S Z, Robbins R C, Hunt S A. Longer-term risks associated with 10-year survival after heart transplantation in the cyclosporine era.  J Heart Lung Transplant. 2003;  22 1098-1106
• 14 Damhuis R AM, Schutte P R. Resection rates and postoperative mortality in 7899 patients with lung cancer.  Eur Respir J. 1996;  9 7-10
• 15 De Perrot M, Wiggle D A, Pierre A F. et al . Bronchogenic carcinoma after solid organ transplantation.  Ann Thorac Surg. 2003;  75 367-371
• 16 Ahmed Z, Blair Marshall M, Kucharczuk J C, Kaiser L R, Shrager J B. Lung cancer in transplant recipients: a single institution experience.  Arch Surg. 2004;  139 902-906
• 17 Gavelli G, Giampalma E. Sensitivity and specificity of chest X‐ray screening for lung cancer: review article.  Cancer. 2000;  89 (Suppl 11) 2453-2456
• 18 Potchen E I, Bisesi M A. When is it malpractice to miss lung cancer on chest radiographs?.  Radiology. 1990;  175 145-150
• 19 Quekel L O, Kessels A G, Goei R. et al . Miss rate of lung cancer on the chest radiograph in clinical practice.  Chest. 1999;  115 720-732
• 20 Henschke C I, Yanklevitz D F, Smith J P. et al . CT screening for lung cancer: assessing a regimen's diagnostic performance.  Clin Imaging. 2004;  28 317-321