Cancer incidence in immunocompromised patients: a single-center cohort study

Area of Science:

• Immunology
• Oncology
• Transplantation Medicine

Background:

• Diminished immune defense is linked to cancer development, potentially altering cancer risk in immunocompromised individuals.
• Identifying high-risk populations is crucial for proactive cancer screening strategies.

Purpose of the Study:

• To compare cancer incidence and risk across three distinct patient groups: solid organ or hematopoietic stem cell transplant (SOT/HSCT) recipients, patients with primary or secondary immunodeficiency disorders (PID/SID), and recipients of tumor necrosis factor inhibitor (TNF-i) therapy.
• To identify independent risk factors for cancer development in these cohorts.

Main Methods:

• Retrospective cohort study utilizing the University of Utah Health System database and Huntsman Cancer Institute tumor registry.
• Inclusion criteria: patients aged ≥18 years with SOT/HSCT, PID/SID, or ≥3 months of TNF-i therapy.
• Kaplan-Meier method for cumulative cancer incidence and Cox-proportional hazard regression for risk factor identification.

Main Results:

• The study included 13,887 patients: 21% SOT/HSCT, 54% PID/SID, and 24% TNF-i recipients.
• Cumulative cancer incidence was 11.5% (SOT/HSCT), 14.3% (PID/SID), and 8.8% (TNF-i).
• Adjusted hazard ratios showed significantly increased cancer risk in SOT/HSCT (1.57) and PID/SID (2.14) cohorts compared to the TNF-i cohort.

Conclusions:

• Primary/secondary immunodeficiency disorder (PID/SID) and SOT/HSCT patients exhibit a significantly higher cancer risk than TNF-i recipients.
• Age (≥50 years), male gender, and comorbidities are additional risk factors for cancer.
• PID/SID and SOT/HSCT patients may benefit from intensified cancer screening protocols.