Lung Cancer in Lung Transplant Recipients: Clinical, Radiologic, and Pathologic Characteristics and Treatment Outcome.
Lung Cancer in Lung Transplant Recipients: Clinical, Radiologic, and Pathologic Characteristics and Treatment Outcome.
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肺移植受者的肺癌：临床、放射学和病理学特征和治疗结果。
DOI：
10.1097/rct.0000000000001466
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发表时间：
2023
影响因子：
1.3
通讯作者：
Nishino,Mizuki
中科院分区：
文献类型：
--
作者：
Tseng,Shu-Chi;Gagne,StaciM;Hatabu,Hiroto;Lin,Gigin;Sholl,LynetteM;Nishino,Mizuki
目的探讨肺移植受者肺癌的临床和影像学特征，评估治疗过程和预后。方法纳入2005年至2021年间接受肺移植的448例患者。所有患者均进行了移植前胸部计算机断层扫描（CT），429例患者进行了移植后CT，19例患者没有进行移植后CT（移植后CT中位数为6；范围为0-24）。对这些患者的医疗记录进行审查，以确定肺移植后患肺癌的患者。回顾肺癌诊断时的计算机断层扫描和正电子发射断层扫描/CT，以获得影像学特征。使用Fisher精确检验和Wilcoxon秩和检验比较人口统计学、肿瘤组织学、分期和生存率。结果在肺移植后中位随访时间为71.3个月的448名肺移植受者中，15名患者（3.3%）发生移植后肺癌（13名单侧，2名双侧；10名男性，5名女性；中位年龄，63.1岁；从移植到癌症诊断的中位时间，3.1年）。 12 例癌症发生在自体肺中，3 例发生在移植肺中。单肺移植受者的肺癌发病率高于双肺移植受者（分别为10.3%和0.6%；P<0.0001）。影像学表现根据肿瘤分期的不同而不同。在 12 名肺癌患者中，2 名患者出现治疗后急性呼吸窘迫综合征。癌症诊断后的中位生存期为 6.2 个月。结论 3% 的肺移植受者出现移植后肺癌，且在单侧移植受者中更为常见。诊断后预后较差，临床恶化迅速，治疗后并发症严重。
ObjectiveThis study aimed to investigate clinical and radiologic characteristics of lung cancer in lung transplant recipients and evaluate the treatment course and prognosis.MethodsThe study included 448 patients who underwent lung transplant between 2005 and 2021. All patients had pretransplant chest computed tomography (CT), 429 patients had posttransplant CT, whereas 19 had no posttransplant CT (median number of posttransplant CT, 6; range, 0–24). Medical records of these patients were reviewed to identify patients who developed lung cancer after lung transplant. Computed tomography and positron emission tomography/CT at the time of lung cancer diagnoses were reviewed to obtain imaging features. Demographics, tumor histology, stages, and survival were compared using Fisher exact test and Wilcoxon rank sum test.ResultsAmong 448 lung transplant recipients with a median follow-up of 71.3 months after lung transplant, 15 patients (3.3%) developed posttransplant lung cancer (13 unilateral, 2 bilateral; 10 men, 5 women; median age, 63.1 years; median time from transplantation to cancer diagnosis, 3.1 years). Twelve cancers were in native lung, and 3 were in transplanted lung. The incidence of lung cancer was higher in single lung transplant recipients than in bilateral lung transplant recipients (10.3% vs 0.6%, respectively; P< 0.0001). Imaging manifestations varied according to tumor stages. Among 12 patients treated for lung cancer, 2 patients developed posttreatment acute respiratory distress syndrome. The median survival from cancer diagnosis of cancer was 6.2 months.ConclusionsPosttransplant lung cancer was noted in 3% of lung transplant recipients and was more common in unilateral transplant recipients. The prognosis upon diagnosis was poor with rapid clinical deterioration and serious posttreatment complications.