Risk of cancer after lung transplantation for COPD

Figures & data

Table 1 Characteristics of 331 patients at the time of lung transplantation in Sweden

Characteristic	All patients (n=331)
Women	213 (64)
Age of recipient, years	55 (7)
Body mass index, kg/m^2	22 (4)
Pack-years of smoking	25 (12)
Severe AATD	125 (38)
Previous lung volume reduction surgery	35 (11)
Long-term oxygen therapy before LTx	210 (63)
FEV1, % of predicted	23 (8)
FVC, % of predicted	62 (19)
DLCO, % of predicted	26 (10)
Age of donor, years	46 (16)
CMV mismatch	44/288 (15)
Single lung transplant	243 (71)
Cardiopulmonary bypass during LTx	38 (11)
Allograft ischemia time, minutes	268 (113)

Note: Data presented as mean (SD) or frequency (percentage).

Abbreviations: AATD, alpha-1-antitrypsin deficiency; CMV, cytomegalovirus; DLCO, diffusing lung capacity for carbon monoxide; LTx, lung transplantation.

Table 2 Risk of cancer in patients after lung transplantation for COPD (n=331) compared with the matched Swedish general population

Site	Observed/expected cancer	SIR (95% CI)	p-value
All types of cancer	118/12	10.0 (8.1–11.8)	<0.001
All skin cancers	54/2	27.0 (20.3–35.2)	<0.001
All non-skin cancers	64/11.4	5.6 (4.3–7.2)	<0.001
Lip and oral cavity	1/0.22	4.6 (0.2–25.0)	0.090
Digestive organs	17/1.8	9.0 (5.1–14.3)	<0.001
Stomach	1/0.16	6.4 (0.2–35.5)	0.55
Colorectal	13/1.1	11.4 (6.1–19.5)	<0.001
Liver	3/0.17	17.7 (3.6–51.6)	<0.001
Respiratory organs	19/0.97	19.6 (11.8–30.6)	<0.001
Larynx	1/0.04	25.0 (0.63–139.3)	<0.001*
Lung	18/0.91	19.8 (11.7–31.2)	<0.001
Reproductive and genitourinary organs	13/5.97	2.2 (1.2–3.7)	0.004
Breast	4/2.72	1.5 (0.4–3.8)	0.44
Uterus	4/0.62	6.4 (1.8–16.5)	<0.001
Vulva	1/0.05	21.7 (0.6–121.0)	<0.001*
Prostate	3/1.60	1.9 (0.4–5.5)	0.27
Urinary bladder	1/0.39	2.6 (0.1–14.4)	0.33
Lymphatic and hematological	14/0.74	19.0 (10.3–31.7)	<0.001
Non-Hodgkin lymphoma	13/0.33	39.0 (20.8–66.7)	<0.001
Leukemia	1/0.11	9.4 (0.2–52.1)	0.007*

Notes: Relative risk of cancer in patients after lung transplantation for COPD, expressed as standardized incidence ratio (SIR) compared with the general Swedish population matched for age, sex, and calendar year. Values in bold highlight significant difference between patients and controls.

* Significance should be interpreted with caution due to few cases.

Table 3 Risk factors for cancer after lung transplantation for COPD (n=311)

Factor	Univariate		Multivariate
	HR (95% CI)	p-value	HR (95% CI)	p-value
Age of recipient (per 1 year)	1.03 (1.01–1.06)	0.011	1.04 (0.99–1.08)	0.10
Women vs men	1.15 (0.79–1.67)	0.47	1.51 (0.86–2.65)	0.15
Non-AATD vs AATD	1.04 (0.72–1.49)	0.84	0.71 (0.37–1.36)	0.31
BMI (per 1 kg/m^2)	0.98 (0.92–1.03)	0.43	0.98 (0.91–1.06)	0.61
Smoking (per 1 pack-year)	0.99 (0.97–1.00)	0.14	0.98 (0.96–1.01)	0.13
Oxygen therapy use before LTx	1.00 (0.67–1.49)	0.99	0.93 (0.54–1.62)	0.81
Bilateral vs single LTx	0.82 (0.52–1.29)	0.38	0.84 (0.43–1.62)	0.59
Age of donor (per 1 year)	1.00 (0.99–1.02)	0.51	1.00 (0.99–1.02)	0.86
CMV mismatch	0.82 (0.50–1.37)	0.45	0.99 (0.50–1.95)	0.97
Days on wait list (per 1 day)	1.00 (1.00–1.00)	0.28	1.00 (1.00–1.00)	0.99
Allograft ischemic time (per 1 min)	1.00 (1.00–1.00)	0.87	–

Notes: Associations with time to first cancer diagnosis after lung transplantation analyzed using univariable and multivariable Fine-Gray regression. Allograft ischemic time was excluded from the multivariable model due to a high rate of missing values (n=153).

Abbreviations: AATD, alpha-1-antitrypsin deficiency; BMI, body mass index; CMV, cytomegalovirus; LTx, lung transplantation.

Figure 1 Kaplan–Meier curves illustrating survival after cancer in 118 lung transplant patients.