Abstract
Background Lung transplant recipients (LTRs) commonly have a long history of tobacco use and an increased genitourinary cancer (GUC) risk, but do not undergo routine GUC surveillance. This study describes the clinical outcomes of GUC among LTRs. Methods We conducted a single-center retrospective cohort study of LTRs diagnosed with GUC between January 2015 and June 2020. Chi-Square was used to calculate p values; Kaplan-Meier curves and log-rank tests compared median survival between LTRs with muscle invasive bladder cancer (MIBC) and those with non-MIBC. Results Of 835 LTRs transplanted between June 2010 and June 2020, 15 developed GUC (cumulative incidence, 1.8%): 13 had bladder cancer (BC) and 2 had ureteral cancer. All patients with GUC had underlying restrictive lung disease (RLD) or obstructive lung disease (OLD) (4/497 [0.8%] RLD vs. 11/281 [3.9%] OLD; p = 0.002); most had a ≥ 20 pack-year smoking history (14/15 [93.3%]). The median time from LT to GUC diagnosis was 75 months (IQR 52.1-103.6), the median age was 72.5 years (IQR 68-77.8), and 11/15 (73.3%) were male. Pathology showed muscle invasion in 9/15 (60%) LTRs, high-grade histology in 13/15 (86.7%), and lymphovascular invasion in 5/12 (41.7%). Of 14 patients with available tumor staging, 1 (7.1%) had pTa disease, 5 (35.7%) had pT1, 8 (57.1%) had pT2-pT4, and 3/15 (20%) had metastatic disease. All 13 LTRs with BC underwent transurethral resection of the bladder tumor, 4 (30.7%) had a subsequent cystoprostatectomy, 2 (15.4%) were treated with systemic chemotherapy, 2 (15.4%) with intravesical chemotherapy, and 3 (23.1%) with radiation. Of the 2 LTRs with ureteral cancer, one underwent nephroureterectomy with tumor debulking, and the other a ureterectomy and radiotherapy of pelvic nodes. Eleven (73.3%) patients were deceased at chart abstraction with a median time to death after GUC diagnosis of 196 days (IQR 90-279 days). The patient with pTa BC died 1681 days after diagnosis, succumbing to unrelated Merkel cell carcinoma. Among LTRs with BC, those with MIBC (n = 7) had a shorter survival than those with non-MIBC (n = 6) (171 vs. 358 days; p = 0.058). Conclusions GUCs manifest late after lung transplant, are frequently high-grade and muscle-invasive at presentation, and portend limited long term survival. These findings highlight the need for increased post-LT GUC surveillance, particularly among high-risk LTRs with a smoking history. This abstract is funded by: None