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Incidental Lung Cancer of Explanted Lungs from Lung Transplant Recipients: Incidence, Characteristics, and 5-Year Survival

 Yong Jun Choi  ;  Song Yee Kim  ;  Moo Suk Park  ;  Jin Gu Lee  ;  Hyo Chae Paik  ;  Sang Hoon Lee 
 YONSEI MEDICAL JOURNAL, Vol.61(11) : 958-964, 2020-11 
Journal Title
Issue Date
Adenocarcinoma / mortality ; Adenocarcinoma / pathology ; Adult ; Female ; Follow-Up Studies ; Humans ; Incidence ; Incidental Findings ; Lung / diagnostic imaging* ; Lung / pathology ; Lung Diseases, Interstitial / complications ; Lung Diseases, Interstitial / surgery ; Lung Neoplasms / mortality ; Lung Neoplasms / pathology* ; Lung Neoplasms / therapy* ; Lung Transplantation / adverse effects* ; Male ; Middle Aged ; Pneumonectomy ; Prevalence ; Prognosis ; Retrospective Studies ; Tissue Donors ; Tomography, X-Ray Computed ; Transplant Recipients ; Treatment Outcome
Non-small cell lung cancer ; lung transplantations ; transplant recipient
Purpose: Recent history of malignancy without 5-year disease-free interval is an absolute contraindication for lung transplantation (LTx). However, in rare cases, lung cancer may be incidentally diagnosed in the explanted lung of recipients. We evaluated the prevalence, 5-year survival, and prognosis of incidental lung cancer after LTx. Materials and methods: Medical records of patients who underwent LTx at Severance Hospital between January 1, 2012 and June 30, 2019 were reviewed. Patients with incidental lung cancer were included, and those with histologically proven pre-transplant lung cancer were excluded. Results: Of the 247 patients who underwent LTx, 6 (2.4%) were diagnosed with incidental lung cancer. Interstitial lung disease (ILD) was the underlying lung disease in all patients. The median interval from the last preoperative computed tomography (CT) screening to LTx was 26 days. The most common histological type of incidental lung cancer was adenocarcinoma (n=4, 66.7%). All Stage IV cases were misdiagnosed as fibrosis on preoperative chest CT. Patients with incidental lung cancer showed lower 5-year survival than those without malignancy (median survival: 8.5 months vs. not reached, p=0.047, respectively). Patients with Stage III or IV demonstrated lower 5-year survival than those with Stage I or II and those without malignancy (median survival: 5 months, 19 months, and not reached, respectively, p=0.011). Conclusion: Multidisciplinary preoperative screening and serial imaging studies within short intervals are required to differentiate lung malignancy from fibrotic foci. Furthermore, active pathologic examination of suspicious lung lesions is required in patients at high risk for lung cancer.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Paik, Hyo Chae(백효채) ORCID logo https://orcid.org/0000-0001-9309-8235
Lee, Sang Hoon(이상훈) ORCID logo https://orcid.org/0000-0002-7706-5318
Lee, Jin Gu(이진구)
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