Liang E, Gilbert M, and Siddiqui F. Recurrence of Primary Mucosal Head and Neck Squamous Cell Carcinoma in Solid Organ Transplant Recipients. American Journal of Clinical Oncology-Cancer Clinical Trials 2021; 44(10):S85-S85.
Am J Clin Oncol
Background: Patients that undergo a solid organ transplant have been shown to have a higher risk of developing cancer and even subsequent recurrences due to the immunosuppressants required to prevent rejection. Most established literature has been in the setting of cutaneous malignancies. In this study, we examine patients diagnosed with primary mucosal head and neck squamous cell carcinomas (HNSCC) diagnosed post-transplant to analyze their disease characteristics and clinical outcomes.
Objectives: To retrospectively characterize patients with primary mucosal HNSCC with history of prior solid organ transplant to define patient and tumor factors as well as analyze their long-term outcomes. Methods: IRB approval was obtained for a retrospective evaluation utilizing our institutional head and neck cancer database. The analysis included patients who had previously undergone a solid organ transplant and subsequently were diagnosed with a primary mucosal HNSCC. These included patients diagnosed from March 2006 to March 2021. The onset of recurrence was analyzed to identify long-term health implications for this patient cohort. Kaplan-Meier analyses were performed to calculate overall and disease-free survival.
Results: Out of 1,221 patients in our database, 24 patients met the inclusion criteria. Three patients were excluded due to lack of treatment or follow-up information, creating a sample of 21 patients. Of these, 13 (61.9%) received a liver, 4 (19%) received a kidney, 1 (4.8%) received a lung, and 3 (14.3%) received two transplants. After receiving the transplant, the median time to a HNSCC diagnosis was 6.4 years (range of 0.5 y to 18.5 y). The primary tumors included 8 (36.3%) oropharyngeal, 8 (36.3%) oral cavity, 5 (22.7%) laryngeal, and 1 (4.5%) hypopharyngeal lesion for a total of 22 lesions, with one patient having concurrent primaries of the oral cavity and oropharynx. The cohort included 1 (4.7%) stage 0, 7 (33.3%) stage I, 3 (14.3%) stage II, 3 (14.3%) stage III, and 7 (33.3%) stage IV; no patients had distant metastasis at time of diagnosis. Of the patients, 7 (33.3%) were treated with surgery alone, 6 (28.6%) received post-operative radiation/chemoradiation, 6 (28.6%) were treated with definitive chemoradiation, and 2 (9.5%) received definitive radiation. Median overall survival was 31 months. After treatment, 6 (28.6%) patients experienced a recurrence. Disease-free survival was 72.1% at 12 months. All patients who had a recurrence also died within the follow-up period. The median time of death after recurrence for all six patients was 11.5 months (range of 1 month to 22 mo).
Conclusions: Solid organ transplant patients are at a higher risk of developing many different cancers. Treatment of primary mucosal HNSCC is frequently done with curative intent and can be associated with significant morbidity. A better understanding of how solid organ transplant history modifies the disease course can help properly guide treatment decisions. In particular, this series highlights a high rate of mortality among patients who experience a disease recurrence. Further research is needed to better understand the risks associated with recurrence in solid organ transplant patients.