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Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Transplant Oncology".

Deadline for manuscript submissions: closed (31 July 2024) | Viewed by 9533

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Special Issue Editors

Dr. Andrea Dell'Amore

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Division of Thoracic Surgery, Padua University Hospital, 35128 Padua, Italy
Interests: heart transplantation; lung transplantation; heart and lung transplantation; pulmonary artery hypertension; pulmonary thromboendoarterctomy; ECMO; cardiac assistance devices; tracheal surgery; robotic surgery; minimally invasive cardiothoracic surgery
Special Issues, Collections and Topics in MDPI journals

Dr. Eleonora Faccioli

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Guest Editor

Thoracic Surgery Unit, Department of Cardiothoracic Surgery and Vascular Sciences, Padua University Hospital, University of Padua, 35122 Padua, Italy
Interests: lung cancer; mesothelioma; robotic surgery; minimally invasive surgery; immunotherapy; clinical trials
Special Issues, Collections and Topics in MDPI journals

Dr. Alessio Campisi

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Guest Editor

Thoracic Surgery Unit, Cardiovascular and Thoracic Department, University and Hospital Trust-Ospedale Borgo Trento, 37126 Verona, Italy
Interests: minimally invasive surgery; robotic surgery; immunotherapy; lung cancer; ERAS; postoperative in thoracic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Lung transplantation and lung cancer appear to be two distinct topics that require very different treatments and management. Anyone involved in lung transplantation programs is aware of the risk of having transplant patients with lung cancer. In fact, there are at least four clinical scenarios that combine lung transplantation and lung cancer. The first is that of a patient who in the past had and was treated for lung cancer and who is now, for various reasons, a possible candidate for lung transplantation. The second scenario is that of the lung transplant patient where an occult lung neoplasm is found on the explanted native lung. The third scenario is that of the lung transplant patient who develops lung cancer in the medium-long term follow-up. The rarest scenario is the planned transplantation for patients with lung cancer. Could lung transplantation be a curative option in selected cases?

The purpose of this Special Issue is to collect experiences in each of these scenarios which do not yet have well-defined management or treatment guidelines. Original works of an oncological, surgical, and ethical nature will be considered in order to explore the clinical practice of centers with experience in this field.

Dr. Andrea Dell'Amore
Dr. Eleonora Faccioli
Dr. Alessio Campisi
Guest Editors

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Keywords

organ transplantation
lung cancer
lung transplant
transplant oncology
transplant complication

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Published Papers (6 papers)

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Research

11 pages, 512 KiB

Open AccessArticle

Cine-MRI and T1TSE Sequence for Mediastinal Mass

by Matthias Grott, Nabil Khan, Martin E. Eichhorn, Claus Peter Heussel, Hauke Winter and Monika Eichinger

Cancers 2024, 16(18), 3162; https://doi.org/10.3390/cancers16183162 - 15 Sep 2024

Viewed by 1004

Abstract

Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value. Full article

(This article belongs to the Special Issue Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives)

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15 pages, 1445 KiB

Open AccessArticle

Perioperative Predictive Factors for Tumor Regression and Survival in Non-Small Cell Lung Cancer Patients Undergoing Neoadjuvant Treatment and Lung Resection

by Fuad Damirov, Mircea Gabriel Stoleriu, Farkhad Manapov, Enole Boedeker, Sascha Dreher, Sibylle Gerz, Thomas Hehr, Evelin Sandner, German Ott, Rudolf Alexander Hatz and Gerhard Preissler

Cancers 2024, 16(16), 2885; https://doi.org/10.3390/cancers16162885 - 20 Aug 2024

Viewed by 1170

Abstract

Our study aimed to identify predictors for the effectiveness of tumor regression in lung cancer patients undergoing neoadjuvant treatment and cancer resections. Patients admitted between 2016 and 2022 were included in the study. Based on the histology of the tumor, patients were categorized into a lung adenocarcinoma group (LUAD) and squamous cell carcinoma group (SQCA). Ninety-five patients with non-small-cell lung cancer were included in the study. A total of 58 (61.1%) and 37 (38.9%) patients were included in the LUAD and SQCA groups, respectively. Additionally, 9 (9.5%), 56 (58.9%), and 30 (31.6%) patients were categorized with a tumor regression score of I, II, and III, respectively. In multivariable analyses, histology of the primary tumor (SQCA), lymph node size in the preoperative CT scan (>1.7 cm), and absolute tumor size reduction after neoadjuvant treatment (>2.6 cm) independently predict effectiveness of tumor regression (OR [95% confidence interval, p-value] of 6.88 [2.40–19.77, p < 0.0001], 3.13 [1.11–8.83, p = 0.0310], and 3.76 [1.20–11.81, p = 0.0233], respectively). Age > 70 years, extended resection > one lobe, and tumor recurrence or metastasis were identified as significant independent predictors of reduced overall survival. Assessment of tumor size before and after neoadjuvant treatment might help to identify high-risk patients with decreased survival and to improve patient management and care. Full article

(This article belongs to the Special Issue Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives)

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11 pages, 1397 KiB

Open AccessArticle

Lung Resection for Non-Small Cell Lung Cancer following Bronchoscopic Lung Volume Reduction for Heterogenous Emphysema

by Alfonso Fiorelli, Beatrice Leonardi, Gaetana Messina, Luca Luzzi, Piero Paladini, Chiara Catelli, Fabrizio Minervini, Peter Kestenholz, Leonardo Teodonio, Antonio D’Andrilli, Erino Angelo Rendina and Giovanni Natale

Cancers 2024, 16(3), 605; https://doi.org/10.3390/cancers16030605 - 31 Jan 2024

Cited by 1 | Viewed by 1722

Abstract

Bronchoscopic lung volume reduction (BLVR) is a minimally invasive treatment for emphysema. Lung cancer may be associated with emphysema due to common risk factors. Thus, a growing number of patients undergoing BLVR may develop lung cancer. Herein, we evaluated the effects of lung resection for non-small cell lung cancer in patients undergoing BLVR. The clinical data of patients undergoing BLVR followed by lung resection for NSCLC were retrospectively reviewed. For each patient, surgical and oncological outcomes were recorded to define the effects of this strategy. Eight patients were included in our series. In all cases but one, emphysema was localized within upper lobes; the tumor was detected during routine follow-up following BLVR and it did not involve the treated lobe. The comparison of pre- and post-BLVR data showed a significant improvement in FEV1 (29.7 ± 4.9 vs. 33.7 ± 6.7, p = 0.01); in FVC (28.5 ± 6.6 vs. 32.4 ± 6.1, p = 0.01); in DLCO (31.5 ± 4.9 vs. 38.7 ± 5.7, p = 0.02); in 6MWT (237 ± 14 m vs. 271 ± 15 m, p = 0.01); and a reduction in RV (198 ± 11 vs. 143 ± 9.8, p = 0.01). Surgical resection of lung cancer included wedge resection (n = 6); lobectomy (n = 1); and segmentectomy (n = 1). No major complications were observed and the comparison of pre- and post-operative data showed no significant reduction in FEV1% (33.7 ± 6.7 vs. 31.5 ± 5.3; p = 0.15) and in DLCO (38.7 ± 5.7 vs. 36.1 ± 5.4; p = 0.15). Median survival was 35 months and no cancer relapses were observed. The improved lung function obtained with BLVR allowed nonsurgical candidates to undergo lung resection for lung cancer. Full article

(This article belongs to the Special Issue Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives)

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14 pages, 1327 KiB

Open AccessArticle

Microscopical Variables and Tumor Inflammatory Microenvironment Do Not Modify Survival or Recurrence in Stage I-IIA Lung Adenocarcinomas

by Andrea Dell’Amore, Alessandro Bonis, Luca Melan, Stefano Silvestrin, Giorgio Cannone, Fares Shamshoum, Alberto Zampieri, Federica Pezzuto, Fiorella Calabrese, Samuele Nicotra, Marco Schiavon, Eleonora Faccioli, Marco Mammana, Giovanni Maria Comacchio, Giulia Pasello and Federico Rea

Cancers 2023, 15(18), 4542; https://doi.org/10.3390/cancers15184542 - 13 Sep 2023

Cited by 1 | Viewed by 1211

Abstract

Microscopical predictors and Tumor Immune Microenvironment (TIME) have been studied less in early-stage NSCLC due to the curative intent of resection and the satisfactory survival rate achievable. Despite this, the emerging literature enforces the role of the immune system and microscopical predictors as prognostic variables in NSCLC and in adenocarcinomas (ADCs) as well. Here, we investigated whether cancer-related microscopical variables and TIME influence survival and recurrence in I-IIA ADCs. We retrospectively collected I-IIA ADCs treated (lobectomy or segmentectomy) at the University Hospital (Padova) between 2016 and 2022. We assigned to pathological variables a cumulative pathological score (PS) resulting as the sum of them. TIME was investigated as tumor-infiltrating lymphocytes (TILs < 11% or ≥11%) and PD-L1 considering its expression (<1% or ≥1%). Then, we compared survival and recurrence according to PS, histology, TILs and PD-L1. A total of 358 I-IIA ADCs met the inclusion criteria. The median PS grew from IA1 to IIA, indicating an increasing microscopical cancer activity. Except for the T-SUVmax, any pathological predictor seemed to be different between PD-L1 < 1% and ≥1%. Histology, PS, TILs and PD-L1 were unable to indicate a survival difference according to the Log-rank test (p = 0.37, p = 0.25, p = 0.41 and p = 0.23). Even the recurrence was non-significant (p = 0.90, p = 0.62, p = 0.97, p = 0.74). According to our findings, resection remains the best upfront treatment in I-IIA ADCs. Microscopical cancer activity grows from IA1 to IIA tumors, but it does not affect outcomes. These outcomes are also unmodified by TIME. Probably, microscopical cancer development and immune reaction against cancer are overwhelmed by an adequate R0-N0 resection. Full article

(This article belongs to the Special Issue Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives)

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11 pages, 1660 KiB

Open AccessArticle

Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation

by Eloisa Ruiz, Paula Moreno, Francisco Javier Gonzalez, Alba Maria Fernandez, Benito Cantador, Juan Luis Parraga, Angel Salvatierra and Antonio Alvarez

Cancers 2023, 15(15), 4011; https://doi.org/10.3390/cancers15154011 - 7 Aug 2023

Cited by 4 | Viewed by 2027

Abstract

(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung transplants (LT) and their influence on patients’ survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (n = 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%; p = 0.005), transplanted for emphysema (55%; p = 0.003), with cyclosporine-based immunosuppression (58%; p < 0.001), and receiving single LT (65%; p = 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3–2.4; p < 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5–4.4; p < 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung. Full article

(This article belongs to the Special Issue Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives)

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14 pages, 2319 KiB

Open AccessArticle

Predictors of Long-Term Survival of Thoracoscopic Lobectomy for Stage IA Non-Small Cell Lung Cancer: A Large Retrospective Cohort Study

by Piotr Gabryel, Piotr Skrzypczak, Alessio Campisi, Mariusz Kasprzyk, Magdalena Roszak and Cezary Piwkowski

Cancers 2023, 15(15), 3877; https://doi.org/10.3390/cancers15153877 - 30 Jul 2023

Cited by 6 | Viewed by 1536

Abstract

The standard of care for patients with early-stage non-small cell lung cancer (NSCLC) is anatomical lung resection with lymphadenectomy. This multicenter, retrospective, cohort study aimed to identify predictors of 5-year survival in patients after thoracoscopic lobectomy for stage IA NSCLC. The study included 1249 patients who underwent thoracoscopic lobectomy for stage IA NSCLC between 17 April 2007, and December 28, 2016. The 5-year survival rate equaled 77.7%. In the multivariate analysis, higher age (OR, 1.025, 95% CI: 1.002 to 1.048; p = 0.032), male sex (OR, 1.410, 95% CI: 1.109 to 1.793; p = 0.005), chronic obstructive pulmonary disease (OR, 1.346, 95% CI: 1.005 to 1.803; p = 0.046), prolonged postoperative air leak (OR, 2.060, 95% CI: 1.424 to 2.980; p < 0.001) and higher pathological stage (OR, 1.271, 95% CI: 1.048 to 1.541; p = 0.015) were related to the increased risk of death within 5 years after surgery. Lobe-specific mediastinal lymph node dissection (OR, 0.725, 95% CI: 0.548 to 0.959; p = 0.024) was related to the decreased risk of death within 5 years after surgery. These findings provide valuable insights for clinical practice and may contribute to improving the quality of treatment of early-stage NSCLC. Full article

(This article belongs to the Special Issue Lung Transplantation and Lung Cancer: Clinical Scenarios, Outcomes and Future Perspectives)

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