Resection Warranted In Transplant Recipients With Early Stag

[MJ]

NEW YORK AUG 16, 2004 (Reuters Health) - Although lung cancers seem to progress more rapidly in transplant recipients, new research suggests that surgical resection is often curative, provided that the disease stage is IIB or less.

Between January 1, 1977 and July 31, 2002, Dr. Joseph B. Shrager and colleagues, from the University of Pennsylvania in Philadelphia, identified 5400 patients who underwent solid organ transplantation at their institution. Of these patients, 15 (0.28%) later developed lung cancer-8 who had received kidneys, 3 given lungs, and 4 heart recipients.

On average, lung cancer was diagnosed 76 months after transplantation, according to the report in the Archives of Surgery for August. Although 11 of the 15 patients had a smoking history, "a higher proportion of nonsmokers develop lung cancer in the transplant population than in the general population," the researchers point out.

In terms of histology, the cancers included 6 adenocarcinomas, 5 squamous cell, 2 large cell undifferentiated, 1 bronchoalveolar, and 1 small cell. As for cancer stage, 3 patients had IA or IB disease, 2 had IIB, 2 had IIIA, and 8 had IIIB or IV (inoperable).

Except for the 8 patients with inoperable disease, all of the subjects underwent resection and no major postoperative complications were observed. The average survival periods with inoperable disease and with resected IIIA disease were 1.4 and 6.0 months, respectively. In contrast, with lower stage disease, the mean survival period after resection was 37 months and all patients are currently alive and disease free.

"Regarding lung cancers in transplant recipients compared with lung cancers in the nontransplant population, we find that (1) there is an increased incidence among nonsmokers; (2) death occurs rapidly in unresected patients; (3) resection carries a low morbidity rate; and (4) resection seems to offer a high chance of cure in those with cancers stage IIB or less," the authors state.