Cancer risk in heart or lung transplant recipients: a meta-analysis
Fan Ge1, Runchen Wang2, Zhenyu Huo2, Yaokai Wen2, Hengrui Liang4, Yu Jiang2, Zixuan Su2, Wenhua Liang3, Jianxing He4.
11st Clinical School, Guangzhou Medical University, Guangzhou, People's Republic of China; 2Nanshan School, Guangzhou Medical University, Guangzhou, People's Republic of China; 3Department of Thoracic Oncology, The 1st Affiliated Hosipital of Guangzhou Medical University, Guangzhou, People's Republic of China; 4Department of Thoracic Surgery, The 1st Affiliated Hosipital of Guangzhou Medical University, Guangzhou, People's Republic of China
Background: Patients underwent heart or lung transplantation are considered to be associated with an increased risk of developing cancers. However, the specific cancer risk at different sites among heart or lung transplantation recipients remain unclear. Tumor mutational burden (TMB) is a biomarker, which is a measure of immunogenicity of certain cancer.
Methods: PubMed, Web of Science, EMBASE, Medline, Cochrane Library were searched. Random-effects meta-analyses were performed to calculate standardized incidence ratios (SIRs) for heart or lung transplant recipients versus the general population, stratified by types of transplantation. Weighted linear regression (WLR) was performed to analyze the associations between tumors’ standardized incidence ratios (SIRs) and corresponding tumor mutational burden (TMB).
Results: Based on data from 117,045 transplant recipients (51,173 heart transplant recipients and 65,872 lung transplant recipients) with a total follow-up of 578,014.8 person-years (heart transplantation: 259,913.2 person-years; lung transplantation: 318,101.6 person-years), we identified that heart or lung transplant recipients display a different risk in different cancers. Heart transplant recipients were found to display a higher risk in all cancers [SIR: 3.13; 95% Confidence Interval (CI): 2.38-4.13; P<0.001], squamous cell carcinoma, lip cancer, non-melanoma skin cancer, non-Hodgkin's lymphoma, basal cell cancer, kidney cancer, compared with the general population. Lung transplant recipients were found to display a higher risk in all cancers [SIR: 4.28; 95% CI: 2.98-6.60; P < 0.001], non-Hodgkin's lymphoma, lip cancer, skin cancer, non-melanoma skin cancer, squamous cell carcinoma, lung cancer, head and neck cancer, colorectal cancer, liver cancer, cervical cancer and a lower risk in breast cancer, compared with the general population (Table 1). The correlation coefficient of 0.54 [P = 0.047] and 0.79 [P < 0.001] in heart and lung transplant recipients, respectively, suggested that 27% and 63% of the differences in the standardized incidence ratios across cancer types may be explained by the tumor mutational burden (Figure1).
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