De Novo Colorectal Cancer: Five-Year Survival Is Markedly Lower in Transplant Recipients Compared With the General Population J.F. Buell, H.T. Papaconstantinou, B. Skalow, M.J. Hanaway, R.R. Alloway, and E.S. Woodle ABSTRACT Introduction. The biological behavior of most solid tumors in transplant recipients has not been adequately compared to the general population. The purpose of the present study was to compare outcomes in de novo colorectal cancer (CRC) following solid organ transplantation to those observed in the general population (SEER) database. Methods. All transplant recipients with de novo CRC in the Israel Penn International Transplant Tumor Registry were identified and analyzed and the data were compared to CRC patients in the SEER National Cancer Institute (NCI) database. Results. One hundred and fifty transplant recipients with de novo CRC were identified, among which were 93 (62%) kidney, 29 (19.3%) heart, 27 (18%) liver, and 1 (0.7%) lung recipients. Median age of transplant recipients was 54 years, compared to a median age of 72 years for patients in the SEER NCI database. However, compared to patients from the SEER NCI database, recipients with Duke’s A through C stage disease were noted to experience a significant decrease in 5-year survival. The results in Duke’s C patients were particularly dismal. Conclusions. The early age at presentation of CRC in transplant recipients suggests that the development of de novo CRC may be effected by immunosuppression. Decreased 5-year survival rates in transplant recipients compared to the general population suggest that CRC in transplant patients is biologically more aggressive. These data cannot distinguish whether the lower survival rates are because the CRC are inherently biologi- cally more aggressive or whether immunosuppression allows for more aggressive clinical behavior of CRC. A VERY SMALL NUMBER of de novo colorectal cancers (CRC) following organ transplantation exist in the extant literature. 1–3 As a result, there is no data on the clinical behavior of these tumors relative to the general population. The purpose of this study was to analyze the clinical results with de novo CRC following organ trans- plantation and compare the results to those observed in the general population in the NCI SEER database. METHODS All transplant recipients with de novo CRC in the Israel Penn International Transplant Tumor Registry database were analyzed. Data on patient demographics, tumor stage, tumor location, cadav- eric versus living related donor transplants, and immunosuppres- sion were analyzed. Diagnosis, age, and survival rate were compared to CRC patients in the SEER National Cancer Institute (NCI) database. RESULTS One hundred and fifty solid organ transplant recipients with de novo CRC were identified: 93 (62%) kidney, 29 (19.3%) heart, 27 (18%) liver, and 1 (0.7%) lung transplant recipi- ents. Median age at transplant was 54 years, and median age at CRC diagnosis in transplant patients was 59 years. This compared to a median age of 72 years for patients in the SEER NCI database. Time from transplant to CRC diagnosis, sex, race, tumor location, and tumor stage distri- bution were not different between groups. Recipients of cadaveric renal transplants were also compared to those From the University of Cincinnati, Cincinnati, Ohio, USA. Address reprint requests to Dr E. Steve Woodle, University of Cincinnati, Division of Transplantation, 8425 Preakness Lane, Cincinnati, OH 45249. E-mail: woodlees@uc.edu 0041-1345/05/$–see front matter © 2005 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2004.12.122 360 Park Avenue South, New York, NY 10010-1710 960 Transplantation Proceedings, 37, 960 –961 (2005)