移植前恶性肿瘤患者肺移植后的生存结局和危险因素:一项国家队列研究

IF 3.5 2区 医学 Q2 ONCOLOGY
Translational lung cancer research Pub Date : 2025-07-31 Epub Date: 2025-07-28 DOI:10.21037/tlcr-2025-224
Xiaoqing Lan, Caikang Luo, Junjie He, Yining Pan, Fei Huang, Wei He, Jiaqin Zhang, Yanwei Lin, Zhiwei Wang, Chao Yang, Guilin Peng, Jiang Shi, Xin Xu
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引用次数: 0

摘要

背景:移植前恶性肿瘤(PTM)是肺移植的相对禁忌症。LTx中PTM患者的比例逐年增加。我们试图确定影响患者生存的可改变的危险因素,并评估不同类型PTM的预后。方法:我们回顾性地回顾了美国器官共享网络(UNOS)登记的原发性成人肺移植受者(LTR)。采用PTM进行一级分层,根据肿瘤类型进行二级分层。采用Kaplan-Meier生存分析估计生存率,采用Cox比例风险模型评估危险因素。结果:与非PTM患者相比,移植后1年PTM患者的死亡率显著高于非PTM患者(1年:P=0.02;3-, 5-, 10年:PTM结论:有PTM患者LTx术后预后较无PTM患者差。在关注长期生存时,有肺癌、白血病、黑色素瘤、泌尿生殖系统恶性肿瘤病史的患者需要更谨慎的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Survival outcomes and risk factors after lung transplantation in patients with pre-transplant malignancy: a national cohort study.

Background: Pre-transplant malignancy (PTM) is a relative contraindication for lung transplantation (LTx). The proportion of patients with PTM in LTx is increasing annually. We sought to identify modifiable risk factors affecting patient survival and evaluate the prognosis of different types of PTM.

Methods: We retrospectively reviewed primary adult lung transplantation recipients (LTR) in the United Network for Organ Sharing (UNOS) registry. Primary stratification was performed by PTM and secondary stratification by tumor type. Kaplan-Meier survival analysis was used to estimate survival and Cox proportional hazards model was used to assess risk factors.

Results: Compared to patients without PTM, patients with PTM exhibit a significantly higher mortality rate starting 1 year post-transplantation (1-year: P=0.02; 3-, 5-, 10-year: P<0.001). Multivariate Cox regression analysis identified age, male sex, single LTx, and high lung allocation score (LAS) as independent risk factors for 5-year mortality in PTM patients. After stratifying PTM, lung PTM was an independent risk factor for death at all periods after transplantation (1-year: P<0.001; 3-year: P=0.001; 5-year: P=0.002; 10-year: P=0.005), and leukemia PTM significantly impacted medium- and long-term mortality (3-year: P=0.03; 5-year: P=0.01; 10-year: P=0.004). Additionally, cutaneous melanoma and genitourinary PTM were associated with long-term mortality. Skin cancer, lung cancer and leukemia were significantly associated with cancer-specific mortality (P<0.05).

Conclusions: The prognosis of patients with PTM after LTx is worse than that of patients without PTM. When focusing on long-term survival, patients with a history of lung cancer, leukemia, melanoma and genitourinary system malignant tumors require more careful selection.

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来源期刊
CiteScore
7.20
自引率
2.50%
发文量
137
期刊介绍: Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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