https://orcid.org/0000-0002-9841-5081
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ABSTRACT
Understanding the cancer risks in different transplant recipients helps early detection, evaluation, and treatment of post-transplant malignancies. Therefore, we performed a meta-analysis to determine the cancer risks at multiple sites for solid organ transplant recipients and their associations with tumor mutation burden (TMB), which reflects the immunogenicity. A comprehensive search of PubMed, Web of Science, EMBASE, Medline, and Cochrane Library was conducted. Random effects models were used to calculate the standardized incidence ratios (SIRs) versus the general population and determine the risks of different cancers. Linear regression (LR) was used to analyze the association between the SIRs and TMBs. Finally, seventy-two articles met our criteria, involving 2,105,122 solid organ transplant recipients. Compared with the general population, solid organ transplant recipients displayed a 2.68-fold cancer risk (SIR 2.68; 2.48–2.89; P <.001), renal transplant recipients displayed a 2.56-fold cancer risk (SIR 2.56; 2.31–2.84; P <.001), liver transplant recipients displayed a 2.45-fold cancer risk (SIR 2.45; 2.22–2.70; P <.001), heart and/or lung transplant recipients displayed a 3.72-fold cancer risk (SIR 3.72; 3.04–4.54; P <.001). The correlation coefficients between SIRs and TMBs were 0.68, 0.64, 0.59, 0.79 in solid organ recipients, renal recipients, liver recipients, heart and/or lung recipients, respectively. In conclusion, our study demonstrated that solid organ transplant recipients displayed a higher risk of some site-specific cancers, providing individualized guidance for clinicians to early detect, evaluate, and treat cancer among solid organ transplantation recipients. In addition, the increased cancer risk of solid organ transplant recipients is associated with TMB, suggesting that iatrogenic immunosuppression may contribute to the increased cancer risk in transplant recipients. (PROSPERO ID CRD42020160409).
Author contributions
HZY, GF, XX and WRC designed this study. LCC, CB, LJF and XS searched the literature. HZY, GF and WRC extracted data. HZY, CY, LHR, LWY, PHX and WXR analysed data. HZY and GF wrote the first draft of the manuscript. LCC, HDX, LR and ZR revised the primary version and performed English editing. LWH and HJX revised the final version of the manuscript. All authors contributed to revisions of the manuscript. HZY is the guarantor. All authors approved the final manuscript
Acknowledgments
The authors thank Ms. Lindsey Hamblin for helping to edit the manuscript.
Abbreviations
| BCC | = | Basal Cell Carcinoma |
| CGP | = | Comprehensive Genomic Profiling |
| CI | = | Confidence Interval |
| EBV | = | Epstein-Barr virus |
| HPV | = | Human papillomavirus |
| LR | = | Linear Regression |
| MeSH | = | Medical Subject Headings |
| PRISMA | = | Preferred Reporting Items for Systematic Reviews and Meta‐Analysis |
| SCC | = | Squamous Cell Carcinoma |
| SIR | = | Standardized Incidence Ratio |
| TMB | = | Tumor Mutational Burden |
Conflict of interest
All the authors declare no conflicts of interest.
Ethical statement
This study was approved by the ethics committee of The First Affiliated Hospital of Guangzhou Medical University. Considering that the study was a retrospective analysis, informed consent of all patients was waived by the ethics committee.
Highlights
We summarized the spectrum of overall and site-specific cancer risks in patients with different types of solid organ transplantation, and showed the relationship between TMB and risks of post-transplant cancers.
Supplementary material
Supplemental data for this article can be accessed on the publisher’s website