Risk of cancer after lung transplantation for COPD

Magnus Ekström,¹ Gerdt C Riise,² Hanan A Tanash<sup>3

1</sup>Department of Clinical Sciences, Division of Respiratory Medicine & Allergology, Lund University, Lund, Sweden; ²Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; ³Department of Respiratory Medicine, Skåne University Hospital, Lund University, Malmö, Sweden

Background: The risk of cancer is increased and affects survival after lung transplantation (LTx), but has not been well characterized in COPD. We aimed to evaluate the incidence and prognosis of cancer following LTx for COPD.
Methods: A prospective, population-based study of patients undergoing LTx for end-stage COPD at the two transplantation centers in Sweden between 1990-2013, with follow-up for incident cancer and death, using national registers. The excess risk of cancer was calculated as standardized incidence ratios compared with the general population matched for age, sex, and calendar year. Risk factors for cancer were analyzed using Fine-Gray regression, and survival after cancer diagnosis with Kaplan–Meier.
Results: In total, 331 patients (mean age 55.4 years; 64% women; 97% former smokers) were included. At a median follow-up of 2.8 years, 35% of patients had developed cancer and the risk was increased more than 10-fold ([95% CI] 8.1-11.8). The highest excess risks were for non-Hodgkin lymphoma (20.8-66.7), skin cancer (20.3-35.2), lung (11.7-31.2), liver (3.6-51.6), and colorectal cancer (6.1-19.5). Median survival was longer for skin cancer (8 years; 95% CI, 3-15) compared with non-skin cancer (4 years; 95% CI, 2.8-4.8; p<0.001).
Conclusion: The cancer risk is markedly increased after LTx for COPD. It could not be predicted by the factors evaluated, but contributed significantly to a negative prognosis.

Keywords: cancer, COPD, lung transplantation, severe alpha-1-antitrypsin deficiency, survival