Pneumologie 2014; 68 - P19
DOI: 10.1055/s-0034-1375923

Liver-transplantation-associated lung cancer: A comparison of clinical parameters and outcome

F Kocher 1, A Finkenstedt 2, M Fiegl 1, I Graziadei 3, G Gamerith 1, W Oberaigner 4, W Vogel 2, W Hilbe 1
  • 1UK für Hämatologie und Onkologie, Medizinische Universität Innsbruck
  • 2UK für Gastroenterologie und Hepatologie, Medizinische Universität Innsbruck
  • 3Abteilung für Innere Medizin, Bezirkskrankenhaus Hall
  • 4Department für klin. Epidemiologie/Cancer Registry Tirol, Innsbruck

Background:

The incidence of lung cancer (LC) is increased in patients with history of liver transplantation (LT). The purpose of this study was to compare clinical characteristics and outcome of post liver transplantation lung cancer (PLTLC) patients with cohorts of “transplant naive” LC patients and LT patients without lung cancer.

Methods:

Patients who received a LT or were diagnosed with LC between December 1987 and August 2012 were included into analysis. PLTLC patients were compared a LT cohort (n = 725) and the local LC registry (n = 2558) in regard to demographic parameters, risk factors, LC- and LT- characteristics and outcome. Standardized incidence ratios (SIR) were computed in the classical way after adjustment for sex, age and year of follow up.

Results:

Within the LT cohort 22 patients (17 men, 5 women, mean age LT: 58.4 years) developed PLTLC. SIR for PLTLC was 4.4 in women and 2.6. Median time interval between LT and LC diagnosis was 6.5 years (range: 0.3 – 19.5 years). Pre-transplant hepatocellular carcinoma (46% vs. 31%; p = 0.147) and alcoholic liver disease (50% vs. 24%; p = 0.025) were more often seen in the PLTLC cohort compared to the control LT cohort. In comparison to non-LT associated lung cancer the PLTLC patients more frequently had a squamous cell carcinoma subtype (36% vs. 26%; p = 0.298). Due to annual routine lung cancer screening 27% (n = 6) of the PLTLC patients were detected at stage I with the option of a curative treatment (LC cohort: 5%; p < 0.001). Median Survival was significantly inferior in the PLTLC cohort compared to the LT cohort (9.8 vs. 15.2 years; p = 0.041) and LC patients at stages IIIB-IV (5.5 vs. 11.3 months; p = 0.036).

Conclusion:

The Incidence of lung cancer is significantly increased in the LT population compared to an age and sex matched general population suggesting that other risk factors of LC like smoking are involved. As the prognosis is dismal at advanced stages, a regular lung cancer screening is strongly recommended in LT patients.