Journal article
Sex differences in cancer mortality among solid organ transplant recipients
International journal of cancer, Vol.157(3), pp.427-435
08/2025
DOI: 10.1002/ijc.35415
PMCID: PMC12143962
PMID: 40347031
Abstract
Males have increased mortality after a cancer diagnosis than females, possibly due to poorer immunosurveillance. We tested whether the female survival advantage is lost with immunosuppression by evaluating 17,048 cancer patients (68% male) with a prior solid organ transplant using data from the US Transplant Cancer Match Study and 1,221,914 cancer patients (58% male) from the general population using data from the Surveillance, Epidemiology, and End Results Program. We evaluated 13 solid cancers that occur in both sexes. We compared mortality due to cancer in males and females using a male:female hazard ratio (M:F HR) derived from Cox proportional hazards models adjusted for age, race/ethnicity, diagnosis year, stage, and cancer treatment. Among cancer patients in the general population, males had higher cancer-specific mortality than females for cancers of the lip, stomach, colorectum, anus, liver, lung, skin, brain, and thyroid, with M:F HRs ranging from 1.06 to 1.59. Only colorectal cancer showed an attenuation in the female mortality advantage in transplant recipients (M:F HRTransplant: 0.89; 95% CI: 0.77, 1.03; vs. M:F HRGenPop: 1.07; 95% CI: 1.06, 1.08; P-interaction = 0.007). Among kidney cancer patients, the female mortality advantage was stronger in the transplant population (M:F HRTransplant: 1.33; 95% CI: 1.11, 1.60; M:F HRGenPop: 1.02; 95% CI: 0.99, 1.04; P-interaction = 0.003). Overall, we did not find consistent evidence that the female advantage in cancer mortality is weakened among immunosuppressed transplant recipients, suggesting that non-immune factors contribute to the female advantage among cancer patients in the general population.Males have increased mortality after a cancer diagnosis than females, possibly due to poorer immunosurveillance. We tested whether the female survival advantage is lost with immunosuppression by evaluating 17,048 cancer patients (68% male) with a prior solid organ transplant using data from the US Transplant Cancer Match Study and 1,221,914 cancer patients (58% male) from the general population using data from the Surveillance, Epidemiology, and End Results Program. We evaluated 13 solid cancers that occur in both sexes. We compared mortality due to cancer in males and females using a male:female hazard ratio (M:F HR) derived from Cox proportional hazards models adjusted for age, race/ethnicity, diagnosis year, stage, and cancer treatment. Among cancer patients in the general population, males had higher cancer-specific mortality than females for cancers of the lip, stomach, colorectum, anus, liver, lung, skin, brain, and thyroid, with M:F HRs ranging from 1.06 to 1.59. Only colorectal cancer showed an attenuation in the female mortality advantage in transplant recipients (M:F HRTransplant: 0.89; 95% CI: 0.77, 1.03; vs. M:F HRGenPop: 1.07; 95% CI: 1.06, 1.08; P-interaction = 0.007). Among kidney cancer patients, the female mortality advantage was stronger in the transplant population (M:F HRTransplant: 1.33; 95% CI: 1.11, 1.60; M:F HRGenPop: 1.02; 95% CI: 0.99, 1.04; P-interaction = 0.003). Overall, we did not find consistent evidence that the female advantage in cancer mortality is weakened among immunosuppressed transplant recipients, suggesting that non-immune factors contribute to the female advantage among cancer patients in the general population.
Details
- Title: Subtitle
- Sex differences in cancer mortality among solid organ transplant recipients
- Creators
- Sarah S Jackson - National Cancer InstituteRuth M Pfeiffer - National Cancer InstituteErin Gardner - Texas Department of State Health ServicesMei-Chin Hsieh - Louisiana State University Health Sciences Center New OrleansTabassum Insaf - University at Albany, State University of New YorkCharles F Lynch - University of IowaBozena MorawskiShuhui Wang - Virginia Department of HealthKelly J Yu - National Cancer InstituteEric A Engels - National Cancer Institute
- Resource Type
- Journal article
- Publication Details
- International journal of cancer, Vol.157(3), pp.427-435
- DOI
- 10.1002/ijc.35415
- PMID
- 40347031
- PMCID
- PMC12143962
- NLM abbreviation
- Int J Cancer
- ISSN
- 1097-0215
- eISSN
- 1097-0215
- Publisher
- WILEY
- Grant note
- National Cancer InstituteIntramural Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health
National Cancer Institute This work was supported by the Intramural Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health.
- Language
- English
- Electronic publication date
- 05/09/2025
- Date published
- 08/2025
- Academic Unit
- Epidemiology
- Record Identifier
- 9984820561102771
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