Contents lists available at ScienceDirect Lung Cancer journal homepage: www.elsevier.com/locate/lungcan Characteristics and outcomes of lung cancer in solid organ transplant recipients Lanyi Nora Chen a,b , John Spivack a,c , Thu Cao a,d , Anjali Saqi a,e , Luke J. Benvenuto a,b , William A. Bulman a,b , Matthen Mathew a,b , Mark B. Stoopler a,b , Selim M. Arcasoy a,b , Bryan P. Stanifer a,d , Naiyer A. Rizvi a,b , Catherine A. Shu a,b, * a Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, New York, NY 10032, United States b Department of Medicine, Columbia University Medical Center, United States c Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, United States d Department of Surgery, Columbia University Medical Center, United States e Department of Pathology, Columbia University Medical Center, United States ARTICLE INFO Keywords: Transplant Lung cancer Squamous cell Stabilized propensity score weights Survival ABSTRACT Objectives: Lung cancer is the third most common malignancy that develops in patients following solid organ transplantation and is the leading cause of cancer deaths in the general population. The aims of this study are to examine the characteristics of patients who developed lung cancer following solid organ transplantation at our institution and to compare their outcomes to those of lung cancer patients without a history of transplant. Materials and methods: We performed a single-institution retrospective study of 44 solid organ transplant re- cipients who developed lung cancer and compared their characteristics to a cohort of 74 lung cancer patients without a history of transplant. We performed propensity score weighted analyses to compare outcomes between the two groups, including a cox proportional hazards model of overall survival. Results: 52 % of post-transplant patients who developed lung cancer were diagnosed with stage III or IV disease. In the propensity score weighted analysis that accounted for age at diagnosis, sex, lung cancer stage at diagnosis, Charlson comorbidity index score, and ECOG performance score, post-transplant patients were more likely to have squamous cell histology (p < 0.01) and had worse overall survival compared to the non-transplant cohort (HR = 1.88, 95 % CI 1.13–3.12, p = 0.02). The difference in survival remained significant after accounting for differences in lung cancer histology and treatment (HR = 2.40, 95 % CI 1.27–3.78, p < 0.01). Conclusions: When compared to non-transplant patients with lung cancer, post-transplant patients have worse overall survival after accounting for differences in age, sex, lung cancer stage, comorbidities, and performance status. This survival difference is not solely attributable to differences in tumor histology and treatments re- ceived. This may suggest that post-transplant malignancies are more aggressive and difficult to treat. 1. Introduction The increased risk of malignancy after solid organ transplantation is a well-recognized phenomenon. Prolonged immunosuppressive regi- mens following transplant are thought to confer this risk [1,2]; fur- thermore, once tumors develop in these patients, the impaired host antitumor response increases the risk for metastasis while comorbidities may limit their ability to tolerate chemotherapy. It has been reported that over 4% of solid organ transplant recipients in the United States develop cancer over a 5-year period, with non-melanoma skin cancer, non-Hodgkin’s lymphoma, and lung cancer being the most common post-transplant cancers [1]. Lung cancer incidence is increased espe- cially among heart and lung transplant recipients [3–5], a population of patients with a high incidence of smoking exposure and predisposition caused by underlying lung disease. However, higher incidences have also been reported after kidney and liver transplant [6]. Several studies have commented on the characteristics of lung cancers that develop after solid organ transplantation. In one single https://doi.org/10.1016/j.lungcan.2020.06.018 Received 7 January 2020; Received in revised form 11 June 2020; Accepted 13 June 2020 ⁎ Corresponding author at: Herbert Irving Pavilion, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, United States. E-mail addresses: lnc9005@nyp.org (L.N. Chen), jhs2120@cumc.columbia.edu (J. Spivack), ttc2131@cumc.columbia.edu (T. Cao), aas177@cumc.columbia.edu (A. Saqi), lb2711@cumc.columbia.edu (L.J. Benvenuto), wab10@cumc.columbia.edu (W.A. Bulman), mm4709@cumc.columbia.edu (M. Mathew), mbs5@cumc.columbia.edu (M.B. Stoopler), sa2059@cumc.columbia.edu (S.M. Arcasoy), bps2131@cumc.columbia.edu (B.P. Stanifer), nar2144@cumc.columbia.edu (N.A. Rizvi), cas2145@cumc.columbia.edu (C.A. Shu). Lung Cancer 146 (2020) 297–302 0169-5002/ © 2020 Elsevier B.V. All rights reserved. T