In a study reported in the Journal of Clinical Oncology, Engels et al found that patients with a previous cancer diagnosis who underwent solid organ transplantation had high cancer cure probabilities. Additionally, posttransplantation cancer-specific survival was associated with cancer cure probability at the time of transplantation.
The researchers fitted statistical cure models for patients with cancer in the U.S. general population using data from 13 cancer registries. Patients who subsequently underwent solid organ transplantation were identified from the Scientific Registry of Transplant Recipients. Cure probabilities at diagnosis were estimated for all patients with cancer and at the time of transplantation for patients undergoing transplantation.
Key Findings
Among 10,524,326 patients with 17 cancer types included in the analysis, the median cancer cure probability at diagnosis was 62%. Among these, 5,425 (0.05%) subsequently underwent solid organ transplantation, with these patients having a median cancer cure probability at the time of transplantation of 94% (interquartile range = 86%–98%).
Analysis according to tertile of cure probability at transplantation (divided at 89% and 96%) showed that those in the lowest vs highest tertile were more likely to have lung (4.8% vs 0.2%) or breast cancer (22.5% vs 8.3%) and less likely to have colorectal (8.6% vs 12.4%), testicular (1.1% vs 4.0%), or thyroid cancer (4.7% vs 9.6%). Those in the lowest tertile were more likely to have advanced-stage cancer (eg, localized cancer in 47% vs 73%), to be older (median age = 57 vs 51 years), and more likely to have undergone transplantation sooner after cancer diagnosis (median = 3.6 vs 8.6 years).
In analysis adjusting for calendar year of transplantation, transplanted organ, induction immunosuppression use, baseline maintenance immunosuppressive regimen, and baseline mTOR inhibitor use, compared with patients in the highest tertile, those in the lowest tertile had a significantly increased risk of cancer-specific motility (adjusted hazard ratio [HR] = 2.08, 95% confidence interval [CI] = 1.48–2.93), and those in the middle tertile did not (adjusted HR = 1.11, 95% CI = 0.75–1.65).
In adjusted analysis, no significant difference in noncancer mortality risk was observed for the lowest or middle tertiles vs the highest tertile. Risk of overall morality was significantly increased in the lowest tertile (adjusted HR = 1.21, 95% CI = 1.08–1.36) but not the middle tertile (adjusted HR = 1.11, 95% CI = 0.98–1.25) vs the highest tertile.
The investigators concluded, “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.”
Eric A. Engels, MD, MPH, of the Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Intramural Research Program of the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
