Bronchial carcinoma after lung transplantation: A single-center experience

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• 作者：Jonas Yserbyt ; MD^a ; ^{jonas.yserbyt@uzleuven.be} ; Geert M. Verleden ; MD ; PhD^a ; Lieven J. Dupont ; MD ; PhD^a ; Dirk E. Van Raemdonck ; MD ; PhD^b ; Christophe Dooms ; MD ; PhD^a
• 关键词：lung transplantation ; bronchogenic carcinoma ; epidemiology ; immunosuppression ; survival rate ; mTOR inhibitors
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2012
• 期刊代码：161_10532498
• 类别：med
• 出版时间：June, 2012
• 卷：31
• 期：6
• 页码：585-590
• 文件大小：331 K

摘要

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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 卤 27 (mean 卤 SD) months after LTx. Of these 13 patients, there were 9 men and 4 women. They were transplanted at a mean age of 59 卤 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 (m>pm> = 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 卤 7 months, with a significant survival difference between patients with limited and extensive disease (m>pm> = 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.