Journal article
Risk of Rare Cancers Among Solid Organ Transplant Recipients
JNCI : Journal of the National Cancer Institute, Vol.113(2), pp.199-207
02/01/2021
DOI: 10.1093/jnci/djaa078
PMCID: PMC7850530
PMID: 32462187
Abstract
Abstract
Background
Immunosuppressed solid organ transplant recipients (SOTRs) have elevated rates of certain rare cancers caused by viruses. Evaluating risk of rare cancers among SOTRs may provide etiological clues for additional cancers linked to poor immunity and viral infections.
Methods
We performed a cohort study of 262 455 SOTRs (1987-2014) from the US SOTR registry linked to 17 population-based cancer registries. First cancers in SOTRs were categorized using an established classification scheme based on site and histology. Standardized incidence ratios (SIRs) compared risk in SOTRs with the general population. We used Poisson regression to calculate incidence rate ratios according to immune-related SOTR characteristics, including time since transplant (ie, duration of immunosuppression). All statistical tests were 2-sided.
Results
We examined 694 distinct cancer subtypes, with 33 manifesting statistically significantly elevated SIRs (Bonferroni P < 7.2 × 10–5). All 33 are rare (incidence <6 per 100 000 person-years) and several have known viral etiology (eg, Merkel cell carcinoma: SIR = 24.7, 95% confidence interval [CI] = 20.8 to 29.1). Additional cancers that were increased include squamous cell carcinomas of the lip (SIR range = 18.3-19.8), eye and adnexa (SIR = 13.8, 95% CI = 7.9 to 22.3), salivary gland (SIR = 9.3, 95% CI = 6.1 to 13.5), and nasal cavity and sinuses (SIR = 4.5, 95% CI = 2.8 to 6.8); sebaceous adenocarcinoma (SIR = 34.3, 95% CI = 26.3 to 44.0); malignant fibrous histiocytoma (15.4); and subtypes of bladder, kidney, lung, and colon cancer (SIR range = 3.2-13.3). Incidence of several cancers increased over time since transplant (Ptrend < .05), including squamous cell carcinomas of the lip, salivary gland, and anogenital sites.
Conclusions
SOTRs experience elevated rates of several rare cancers. Because some of these cancers exhibit aggressive behavior with poor outcomes, it is important to further characterize the role of immunity and the potential involvement of oncogenic viruses to improve prevention and treatment.
Details
- Title: Subtitle
- Risk of Rare Cancers Among Solid Organ Transplant Recipients
- Creators
- Monica E D’Arcy - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USADavid Castenson - Information Management Services, Rockville, MD, USACharles F Lynch - Department of Epidemiology, University of Iowa, Iowa City, IA, USAAmy R Kahn - Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, USALindsay M Morton - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USAMeredith S Shiels - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USARuth M Pfeiffer - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USAEric A Engels - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Resource Type
- Journal article
- Publication Details
- JNCI : Journal of the National Cancer Institute, Vol.113(2), pp.199-207
- DOI
- 10.1093/jnci/djaa078
- PMID
- 32462187
- PMCID
- PMC7850530
- NLM abbreviation
- J Natl Cancer Inst
- ISSN
- 0027-8874
- eISSN
- 1460-2105
- Publisher
- Oxford University Press
- Grant note
- name: Minneapolis Medical Research Foundation, Minneapolis, MN; name: National Cancer Institute: California, award: HHSN261201000036C, HHSN261201000035C, HHSN261201000034C
- Language
- English
- Date published
- 02/01/2021
- Academic Unit
- Epidemiology
- Record Identifier
- 9984214939902771
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