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With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant?

Publication ,  Journal Article
Spies, CS; Ochoa, TN; Pontula, A; Harris, CS; Snyder, LD; Pavlisko, EN; Hartwig, MG
Published in: Ann Thorac Surg
September 12, 2023

BACKGROUND: Active primary lung malignancy remains a strong contraindication to lung transplantation (LTx). However, outcomes are unclear for patients with early-stage non-small cell lung cancer (NSCLC) who undergo LTx. We hypothesize that patients with early-stage NSCLC incidentally discovered in the explanted lungs have survival comparable to LTx recipients without incidental cancer identified. METHODS: We performed a single-center retrospective analysis of all LTx recipients from May 2007 to September 2021 with incidental cancer identified in the explanted lungs by pathologist report. Survival statistics were estimated using Kaplan-Meier analysis. RESULTS: Of the 1586 LTx performed, 23 patients (1.5%) were found to have incidental lung cancer in the explanted lungs. The most common indications for LTx were interstitial lung disease (n = 13) and chronic obstructive pulmonary disease (n = 7), and the most common histologic diagnosis was adenocarcinoma (n = 14). In the cohort with stage I disease (n = 9), the 1- and 5-year unadjusted Kaplan-Meier survival rates were 88.9% and 51.9%, respectively. The 1- and 5-year survival rates for transplant recipients without incidental cancer findings at LTx during this period were 86.7% and 59.4%, respectively, and did not differ significantly between the 2 strata (P = .96). CONCLUSIONS: Survival rates at 1 and 5 years were comparable between LTx recipients with incidentally noted pathologic stage I NSCLC and contemporary recipients without cancer. All cancer-related deaths occurred in recipients with incidentally noted advanced NSCLC. These results suggest that patients with pathologic stage I lung cancer at the time of transplant have outcomes comparable to those without cancer findings at the time of transplant.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

September 12, 2023

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Spies, C. S., Ochoa, T. N., Pontula, A., Harris, C. S., Snyder, L. D., Pavlisko, E. N., & Hartwig, M. G. (2023). With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant? Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2023.09.002
Spies, Connor S., Timothy N. Ochoa, Arya Pontula, Chelsea S. Harris, Laurie D. Snyder, Elizabeth N. Pavlisko, and Matthew G. Hartwig. “With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant?Ann Thorac Surg, September 12, 2023. https://doi.org/10.1016/j.athoracsur.2023.09.002.
Spies CS, Ochoa TN, Pontula A, Harris CS, Snyder LD, Pavlisko EN, et al. With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant? Ann Thorac Surg. 2023 Sep 12;
Spies, Connor S., et al. “With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant?Ann Thorac Surg, Sept. 2023. Pubmed, doi:10.1016/j.athoracsur.2023.09.002.
Spies CS, Ochoa TN, Pontula A, Harris CS, Snyder LD, Pavlisko EN, Hartwig MG. With Comparable Outcomes, Should Early-Stage Lung Cancer Be a Contraindication to Lung Transplant? Ann Thorac Surg. 2023 Sep 12;
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

September 12, 2023

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology