Survival after a cancer diagnosis among solid organ transplant recipients in the United States

Monica E D'Arcy; Anna E Coghill; Charles F Lynch; Lori A Koch; Jie Li; Karen S Pawlish; Cyllene R Morris; Chandrika Rao; Eric A Engels

doi:10.1002/cncr.31782

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Survival after a cancer diagnosis among solid organ transplant recipients in the United States

Journal article

Open access

Peer reviewed

Survival after a cancer diagnosis among solid organ transplant recipients in the United States

Monica E D'Arcy, Anna E Coghill, Charles F Lynch, Lori A Koch, Jie Li, Karen S Pawlish, Cyllene R Morris, Chandrika Rao and Eric A Engels

Cancer, Vol.125(6), pp.933-942

03/15/2019

DOI: 10.1002/cncr.31782

PMCID: PMC6403005

PMID: 30624768

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Abstract

Transplant recipients have an elevated risk of cancer because of immunosuppressive medications used to prevent organ rejection, but to the authors' knowledge no study to date has comprehensively examined associations between transplantation status and mortality after a cancer diagnosis. The authors assessed cases in the US general population (N=7,147,476) for 16 different cancer types as ascertained from 11 cancer registries. The presence of a solid organ transplant prior to diagnosis (N=11,416 cancer cases) was identified through linkage with the national transplantation registry (1987-2014). Cox models were used to examine the association between transplantation status and cancer-specific mortality, adjusting for demographic characteristics and cancer stage. For the majority of cancers, cancer-specific mortality was higher in transplant recipients compared with other patients with cancer. The increase was particularly pronounced for melanoma (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [95% CI], 2.18-3.00) and cancers of the breast (aHR, 1.88; 95% CI, 1.61-2.19), bladder (aHR, 1.85; 95% CI, 1.58-2.17), and colorectum (aHR, 1.77; 95% CI, 1.60-1.96), but it also was increased for cancers of the oral cavity/pharynx, stomach, pancreas, kidney, and lung as well as diffuse large B-cell lymphoma (aHR range, 1.21-1.47). Associations remained significant after adjustment for first-course cancer treatment and generally were stronger among patients with local-stage cancers for whom potentially curative treatment was provided, including patients with melanoma (aHR, 3.82; 95% CI, 2.94-4.97) and cancers of the colorectum (aHR, 2.77; 95% CI, 2.07-3.70), breast (aHR, 2.08; 95% CI, 1.50-2.88), and prostate (aHR, 1.60; 95% CI, 1.12-2.29), despite the lack of an association for prostate cancer overall. For multiple cancer types, transplant recipients with cancer appear to have an elevated risk of dying of their cancer, even after adjustment for stage and treatment, which may be due to impaired immunity.

Registries

United States - epidemiology

Humans

Middle Aged

Proportional Hazards Models

Neoplasms - mortality

Male

Neoplasms - diagnosis

Case-Control Studies

Survival Analysis

Aged, 80 and over

Adult

Female

Aged

Organ Transplantation - mortality

Transplant Recipients - statistics & numerical data

Details

Title: Subtitle: Survival after a cancer diagnosis among solid organ transplant recipients in the United States
Creators: Monica E D'Arcy - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
Anna E Coghill - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
Charles F Lynch - Department of Epidemiology, University of Iowa, Iowa City, Iowa
Lori A Koch - Illinois State Cancer Registry, Illinois Department of Public Health, Springfield, Illinois
Jie Li - Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
Karen S Pawlish - Cancer Epidemiology Services, New Jersey Department of Health, Trenton, New Jersey
Cyllene R Morris - California Cancer Reporting and Epidemiologic Surveillance Program, Institute for Population Health Improvement, University of California at Davis Health System, Sacramento, California
Chandrika Rao
Eric A Engels - Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
Resource Type: Journal article
Publication Details: Cancer, Vol.125(6), pp.933-942
Publisher: United States
DOI: 10.1002/cncr.31782
PMID: 30624768
PMCID: PMC6403005
ISSN: 1097-0142
eISSN: 1097-0142
Grant note: N01PC35142 / NCI NIH HHS U58 DP000807 / NCCDPHP CDC HHS U58 DP000824 / NCCDPHP CDC HHS HHSN261201000036C / NCI NIH HHS U58 DP003875 / NCCDPHP CDC HHS U58 DP003931 / NCCDPHP CDC HHS N01PC35137 / NCI NIH HHS U58 DP003921 / NCCDPHP CDC HHS HHSN261201000035C / NCI NIH HHS U58 DP003879 / NCCDPHP CDC HHS HHSN261201300011C / CCR NIH HHS HHSN261201300071C / NCI NIH HHS U58 DP003933 / NCCDPHP CDC HHS U58 DP003920 / NCCDPHP CDC HHS U58 DP000848 / NCCDPHP CDC HHS HHSN261201000034C / NCI NIH HHS N01PC35139 / NCI NIH HHS P30 CA086862 / NCI NIH HHS HHSN261201300021C / NCI NIH HHS HHSN261201300011I / NCI NIH HHS HHSN261201000037C / NCI NIH HHS N01PC35143 / NCI NIH HHS Z99 CA999999 / Intramural NIH HHS HHSN261201300019C / NCI NIH HHS U58 DP003883 / NCCDPHP CDC HHS HHSN261201000035I / NCI NIH HHS
Language: English
Date published: 03/15/2019
Academic Unit: Epidemiology
Record Identifier: 9983995134202771

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