Prognosis of incidental lung cancer in lung transplant candidates

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BACKGROUND: Incidental lung cancer, in the field of lung transplantation (LTx), is more often related to malignancies diagnosed in explants or transplanted organs. Little is known about cancer diagnosed during the medical evaluation of potential LTx candidates. What are the clinical, and prognostic differences between lung cancers diagnosed before or after transplantation in LTx candidates? METHODS: We performed a retrospective, observational, single-center study to describe the characteristics of lung malignancies first discovered during the pre-transplant assessment and then identified in lung explants, over the same period. RESULTS: From 1630 consecutive patients referred to Paris-Bichat Lung Transplant Program from 2006 to 2022, 288 were deemed not suitable for transplantation. The reason was lung malignancy in 20 patients (15 non-small cell lung cancer (NSCLC) proved). The one-year survival rate was 55 %. Seven died from their respiratory insufficiency, and six died from lung cancer progression. Over the same period, 611 patients received LTx. NSCLC were identified in six explants (1 %). One-year survival was 66.7 % in these transplanted patients. CONCLUSIONS: Lung cancer diagnosed during the medical evaluation of potential LTx candidates is rare. However, this represents a critical issue because it contraindicates LTx and leads to a non-optimal management of both lung cancer and of end-stage lung disease. We report an encouraging one-year survival rate in transplanted patients with a pathological lung malignancy diagnosis in lung explant, compared to their counterpart in whom lung cancer discovery contraindicated LTx. A multicenter observational study is mandatory in order to confirm such observation, as it might change current standard to deny LTx in patients with incidental localized NSCLC.

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