Incidence of primary neoplasms in explanted lungs: Long-term follow-up from 214 lung transplant patients
Incidence of primary neoplasms in explanted lungs: Long-term follow-up from 214 lung transplant patients
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DOI：
10.1016/j.transproceed.2004.10.014
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发表时间：
2004-11-01
影响因子：
0.9
通讯作者：
Farver, CF
中科院分区：
文献类型：
--
作者：
Abrahams, NA;Meziane, M;Farver, CF
背景。移植时植入的肺中未发现的肿瘤是不寻常的情况，可能会使这些患者的短期和长期结局显着复杂化。在大量患者中，尚未研究具有临床和放射学相关性的植物植物肺中未发现的原发性肿瘤的发病率和存活。我们回顾了1991年至2000年从克利夫兰诊所基金会的移植中心连续214次肺移植的文件。收集到的数据包括年龄，性别，外植物肺的病理和生存。在移植后检测到主要肿瘤的情况下，对所有成像研究进行了回顾性回顾。 13名男性和101名女性接受以下诊断的肺移植：肺气肿，118；囊性纤维化，35；原发性肺动脉高压，27；通常的间质性肺炎，26岁；淋巴管肌瘤病，4；结节病，2；肺炎和肺炎，2。在外植的肺中发现了四个肿瘤，代表2％的发病率。所有四个肿瘤都是支气管癌，包括三个腺癌和一个鳞状细胞癌。在肺气肿的环境中发现了四个肿瘤中的三个，并在早期（第1阶段）被检测到，在通常的间质性纤维化环境中，第四次作为IV阶段。在I期病例中未发现肿瘤的复发。第四阶段病例在围手术期死亡。对成像研究的回顾性综述表明，在所有四种情况下，在移植物未能识别病变之前就进行了便携式胸部X光片。在移植前3到27个月中，在所有四个病例中均进行了胸部计算机断层图，并在四个结论之一中揭示了可疑病变。移植时植入肺部的肿瘤未发现的肿瘤并不常见，我们机构的发生率为2％。腺癌是最常见的细胞类型。在长期幸存者中，未发现复发。 3年的生存率为50％，这接近了我们机构中没有肺部肿瘤（58.8％）的移植受者的3年生存率。胸部X光片似乎对发现对肿瘤的小病变的敏感性非常低。在移植前立即进行的胸部计算机断层图可能有益于检测这些肿瘤。
Background. Undetected neoplasms in explanted lungs at transplantation are an unusual occurrence that may significantly complicate both the short- and long-term outcome of these patients. The incidence and survival of undetected primary neoplasms in explanted lungs with clinical and radiologic correlation have not been studied in a large cohort of patients.Methods. We reviewed the files of 214 consecutive lung transplants from the Transplant Center at the Cleveland Clinic Foundation from 1991 to 2000. Data collected included age, gender, pathology of explanted lung, and survival. Retrospective review of all imaging studies was performed in those cases where a primary neoplasm was detected after transplant.Results. One hundred thirteen males and 101 females underwent lung transplantation for the following diagnoses: emphysema, 118; cystic fibrosis, 35; primary pulmonary hypertension, 27; usual interstitial pneumonia, 26; lymphangioleiomyomatosis, 4; sarcoidosis, 2; and pneumoconiosis, 2. Four neoplasms were found in the explanted lungs, representing a 2% incidence. All four neoplasms were bronchogenic carcinomas, including three adenocarcinomas and one squamous cell carcinoma. Three of four neoplasms were found in the setting of emphysema and were detected at an early stage (stage 1), and the fourth presented as stage IV in the setting of usual interstitial fibrosis. No recurrence of tumor was seen in the stage I cases. The stage IV case died in the perioperative period. Retrospective review of the imaging studies showed that, in all four cases, a portable chest radiograph performed immediately before transplant failed to identify the lesions. A chest computerized tomogram was performed in all four cases from 3 to 27 months prior to transplantation and revealed a suspicious lesion in one of the four.Conclusions. Undetected neoplasms in explanted lungs at transplantation are uncommon, with an incidence of 2% at our institution. Adenocarcinoma was the most common cell type. In long-term survivors, no recurrences were found. The 3-year survival was 50% and this approaches the 3-year survival of transplant recipients without lung tumors (58.8%) at our institution. Chest radiographs appear to have a very low sensitivity for the detection of small lesions suspicious for a neoplasm. Chest computerized tomograms performed immediately prior to transplantation may be of benefit in detecting these neoplasms.