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Prostate Cancer Outcomes Following Solid-Organ Transplantation: A SEER-Medicare Analysis
Journal article   Open access   Peer reviewed

Prostate Cancer Outcomes Following Solid-Organ Transplantation: A SEER-Medicare Analysis

Stanley L Liauw, Sandra A Ham, Lauren C Das, Sonali Rudra, Vignesh T Packiam, Matthew Koshy, Ralph R Weichselbaum, Yolanda T Becker, Adam S Bodzin and Scott E Eggener
JNCI : Journal of the National Cancer Institute, Vol.112(8), pp.847-854
08/01/2020
DOI: 10.1093/jnci/djz221
PMCID: PMC8453608
PMID: 31728517
url
https://europepmc.org/articles/pmc8453608View
Published (Version of record) Open Access

Abstract

Immunosuppressive regimens associated with organ transplantation increase the risk of developing cancer. Transplant candidates and recipients with prostate cancer are often treated, even if low-risk features would ordinarily justify active surveillance. Using SEER-Medicare, we identified 163 676 men aged 66 years and older diagnosed with nonmetastatic prostate cancer. History of solid organ transplant was identified using diagnosis or procedure codes. A propensity score-matched cohort was identified by matching transplanted men to nontransplanted controls by age, race, region, year, T-stage, grade, comorbidity, and cancer therapy. Fine-Gray competing risk models assessed associations between transplant status and prostate cancer-specific mortality (PCSM) and overall mortality (OM). We identified 620 men (0.4%) with transplant up to 10 years before (n = 320) or 5 years after (n = 300) prostate cancer diagnosis and matched them to 3100 men. At 10 years, OM was 55.7% and PCSM was 6.0% in the transplant cohort compared with 42.4% (P < .001) and 7.6% (P = .70) in the nontransplant cohort, respectively. Adjusted models showed no difference in PCSM for transplanted men (hazard ratio = 0.88, 95% confidence interval = 0.61 to 1.27, P = .70) or differences by prostate cancer therapy. Among 334 transplanted men with T1-2N0, well or moderately differentiated "low-risk" prostate cancer, PCSM was similar for treated and untreated men (hazard ratio = 0.92, 95% confidence interval = 0.47 to 1.81). Among men aged 66 years and older with prostate cancer, an organ transplant is associated with higher OM but no observable difference in PCSM. These findings suggest men with prostate cancer and previous or future organ transplantation should be managed per usual standards of care, including consideration of active surveillance for low-risk cancer characteristics.
 Aged Aged, 80 and over Cohort Studies Humans Immunosuppressive Agents - adverse effects Male Medicare - statistics & numerical data Neoplasm Staging Organ Transplantation - adverse effects Organ Transplantation - statistics & numerical data Postoperative Complications - diagnosis Postoperative Complications - epidemiology Prognosis Propensity Score Prostatic Neoplasms - complications Prostatic Neoplasms - diagnosis Prostatic Neoplasms - epidemiology Prostatic Neoplasms - pathology Risk Factors SEER Program Transplantation Conditioning - adverse effects Transplantation Conditioning - statistics & numerical data Treatment Outcome United States - epidemiology

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