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Malignancy following heart transplantation: differences in incidence and prognosis between sexes - a multicenter
Carlos Minguito-Carazo1, Manuel Gómez-Bueno2,3, Luis Almenar-Bonet4
1Cardiology Department, Complejo Asistencial Universitario de León, Leon, Spain.
Insights
Men face higher malignancy risks after heart transplantation (HT). This study found lower cancer incidence and mortality rates in females post-HT, with better survival outcomes for women diagnosed with cancer.
Area of Science:
- Cardiology
- Oncology
- Transplantation Medicine
Background:
- Male heart transplant (HT) recipients have a known increased risk of malignancy.
- Comprehensive data on cancer incidence and prognosis by gender post-HT is limited.
Purpose of the Study:
- To investigate and compare the incidence, mortality, and survival rates of malignancies between male and female heart transplant recipients.
- To identify gender-specific differences in post-transplant cancer risk and outcomes.
Main Methods:
- Analysis of a large cohort of 5865 heart transplantation patients.
- Calculation of incidence and mortality rates for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs).
- Comparison of survival rates following malignancy diagnosis between genders.
Main Results:
- Females exhibited lower incidence rates for all tumors (25.7 vs. 44.8 per 1000 person-years), SCs, and NSSCs compared to males.
- Mortality rates were significantly lower in females for all tumors and NSSCs.
- Female sex was associated with improved survival after malignancy diagnosis (HR 0.74, P=0.004).
Conclusions:
- Heart transplant recipients, particularly males, have a higher incidence of post-transplant malignancies, especially SCs and NSSCs.
- Females demonstrate better survival outcomes after a cancer diagnosis post-heart transplantation.
- Gender is a significant factor influencing malignancy risk and prognosis in heart transplant recipients.
Abstract:
Male patients are at increased risk for developing malignancy postheart transplantation (HT); however, real incidence and prognosis in both genders remain unknown. The aim of this study was to assess differences in incidence and mortality related to malignancy between genders in a large cohort of HT patients. Incidence and mortality rates were calculated for all tumors, skin cancers (SCs), lymphoma, and nonskin solid cancers (NSSCs) as well as survival since first diagnosis of neoplasia. 5865 patients (81.6% male) were included. Total incidence rates for all tumors, SCs, and NSSCs were lower in females [all tumors: 25.7 vs. 44.8 per 1000 person-years; rate ratio (RR) 0.68, (0.60-0.78), P < 0.001]. Mortality rates were also lower in females for all tumors [94.0 (77.3-114.3) vs. 129.6 (120.9-138.9) per 1000 person-years; RR 0.76, (0.62-0.94), P = 0.01] and for NSSCs [125.0 (95.2-164.0) vs 234.7 (214.0-257.5) per 1000 person-years; RR 0.60 (0.44-0.80), P = 0.001], albeit not for SCs or lymphoma. Female sex was associated with a better survival after diagnosis of malignancy [log-rank p test = 0.0037; HR 0.74 (0.60-0.91), P = 0.004]. In conclusion, incidence of malignancies post-HT is higher in males than in females, especially for SCs and NSSCs. Prognosis after cancer diagnosis is also worse in males.
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