Prognostic implications of lung cancers incidentally identified on explant: A joint study of the Scientific Registry of Transplant Recipients and the National Cancer Database.

Abstract

The implications of a lung malignancy in a lung transplant recipient are poorly understood. Here, we linked national transplant and cancer databases to determine how lung cancer impacted prognosis in lung transplant recipients with incidentally explanted lung cancers (IELCs). Records from the Scientific Registry of Transplant Recipients and National Cancer Database were linked to identify 186 patients who received a lung transplant and were subsequently diagnosed with lung cancer. These patients were determined to have IELC and were compared to control patients who received a lung transplant but were not diagnosed with IELC. Of the 186 patients, 144 had non-small cell lung cancer (NSCLC), 6 had small cell lung cancer, and 36 had a neuroendocrine cancer. Patients with stage I/II NSCLC or any stage neuroendocrine cancer had comparable overall survival and rates of cancer-related mortality compared to controls. Conversely, patients with stage III/IV NSCLC had worse overall survival, higher rates of cancer-related mortality, and infrequently received cancer-specific non-operative treatment. Taken together, stage I/II NSCLC and neuroendocrine cancers should be reconsidered as an absolute contraindication to transplant. Conversely, patients with stage III/IV NSCLC had worse outcomes, and strategies are needed to increase the use of adjuvant therapy.