(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung transplants (LT) and their influence on patients’ survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (n= 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%;p= 0.005), transplanted for emphysema (55%;p= 0.003), with cyclosporine-based immunosuppression (58%;p< 0.001), and receiving single LT (65%;p= 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3–2.4;p< 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5–4.4;p< 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung.
（1）背景：恶性肿瘤是实体器官移植后重要的死亡原因。本研究旨在分析肺移植受者恶性肿瘤的发生率及其对患者生存的影响。（2）方法：回顾性分析1994年至2021年连续进行的肺移植病例。通过单变量与多变量分析比较发生恶性肿瘤与未发生恶性肿瘤的患者群体。采用Kaplan-Meier法与Cox回归分析比较生存差异。（3）结果：731例肺移植中共有91例（12.4%）发生恶性肿瘤，相关死亡率为47%（43例）。自身肺癌、消化系统恶性肿瘤及血液系统恶性肿瘤具有更高的致死率。恶性肿瘤更常见于男性（81%；p=0.005）、因肺气肿接受移植者（55%；p=0.003）、采用环孢素免疫抑制方案者（58%；p<0.001）以及接受单肺移植者（65%；p=0.011）。恶性肿瘤患者（总体）及自身肺癌患者的生存率更差。死亡危险因素包括环孢素免疫抑制方案（OR 1.8；95%CI：1.3-2.4；p<0.001）与新发肺癌（OR 2.6；95%CI：1.5-4.4；p<0.001）。（4）结论：恶性肿瘤是肺移植后不容忽视的重要发病与死亡原因。因肺气肿接受单肺移植的患者尤其面临因保留肺发生肺癌导致的更高死亡风险。
Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation
肿瘤(癌症)患者之家