Bronchial carcinoma after lung transplantation: a single-center experience.

Abstract

BACKGROUND:

Lung transplantation (LTx) remains the best option for selected patients with end-stage lung disease. Long-term survival is hampered by the development of chronic allograft dysfunction, which is the main reason for mortality at 3 to 5 years after LTx. Prevalence of and mortality due to solid-organ tumors also increases and we specifically investigated the development of primary bronchial carcinoma (BC) and its outcome after LTx.

METHODS:

From January 2000 until June 2011, 494 lung and heart-lung transplantations were performed. Among this population, 13 patients developed bronchial carcinoma at 41 ± 27 (mean ± SD) months after LTx. Of these 13 patients, there were 9 men and 4 women. They were transplanted at a mean age of 59 ± 2.8 years; 8 patients were transplanted for emphysema and 5 for pulmonary fibrosis.

RESULTS:

Nine of 92 single LTx patients (transplanted for emphysema or lung fibrosis) developed a bronchial carcinoma in their native lung, whereas only 4 of 224 bilateral LTx patients (also for emphysema or fibrosis) developed a bronchial carcinoma (p = 0.0026). At diagnosis, 4 patients had local disease (cT1N0M0 and cT2N0M0), whereas all others had locoregionally advanced or metastatic disease. Five patients were surgically treated; however, 1 had unforeseen N2 disease with additional pleural metastasis at surgery. All other patients (except 2 who died very soon after diagnosis) were treated with chemotherapy with or without radiotherapy. The median survival after diagnosis was only 10 ± 7 months, with a significant survival difference between patients with limited and extensive disease (p = 0.037). The latter had a median survival of only 6 months compared with 21 months for patients with limited stages of bronchial carcinoma.

CONCLUSIONS:

Bronchial carcinoma, especially of the native lung after single LTx, is a significant problem and the survival after diagnosis is very poor, although patients with limited (operable) disease tend to have better results.

• Authors: Jonas Yserbyt, Geert M Verleden, Lieven J Dupont, Dirk E Van Raemdonck, Christophe Dooms
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 31 Issue 6 Pg. 585-90 (Jun 2012) ISSN: 1557-3117 [Electronic] United States
• PMID: 22425236 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Carcinoma, Bronchogenic (epidemiology, mortality, therapy)
• Combined Modality Therapy
• Drug Therapy
• Female
• Humans
• Lung Neoplasms (epidemiology, mortality, therapy)
• Lung Transplantation
• Male
• Middle Aged
• Postoperative Period
• Prevalence
• Pulmonary Emphysema (surgery)
• Pulmonary Fibrosis (surgery)
• Radiotherapy
• Retrospective Studies
• Survival Rate
• Treatment Outcome