Characteristics and long-term outcomes of head and neck squamous cell carcinoma after solid organ transplantation

• Published in: Oral oncology Vol. 72; pp. 104 - 109
• Main Authors: Alsidawi, Samer, Price, Katharine A., Chintakuntlawar, Ashish V., Westin, Gustavo F., Garcia, Joaquin J., Ma, Daniel J., Okuno, Scott H.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2017
• Subjects: Adult; Aged; Carcinoma, Squamous Cell - pathology; Female; Head and neck cancer; Head and Neck Neoplasms - pathology; HPV; Humans; Immunocompromised host; Male; Middle Aged; Organ Transplantation; Proportional Hazards Models; Recurrence; Retrospective Studies; Solid organ transplant; Squamous Cell Carcinoma of Head and Neck; Survival Analysis; Treatment Outcome; Head and neck cancer; Immunocompromised host; Solid organ transplant; HPV
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2017.07.010

•Survival is poor (39% at 5years) in post-organ transplant patients with HNSCC.•Treatment is well tolerated and no early treatment-related mortality is seen.•There was no evidence of “under treatment” in the first line setting.•The rates of locoregional and distant relapse are high even in early stage disease.•HPV-associated oropharyngeal tumors have favorable survival (67% at 5years).•Older patients have significantly worse outcomes with only 14% alive at 5years. Immunosuppression after solid organ transplant prevents graft rejection, but leads to increased incidence of various malignancies including head and neck squamous cell carcinoma (HNSCC). Outcomes of patients with post-transplant HNSCC are unknown. We retrospectively identified patients who developed HNSCC after solid organ transplant between 1995 and 2010. Adults with pathology-proven HNSCC and adequate follow up were included. Median overall survival and progression free survival were analyzed using the Kaplan-Meier method. The prognostic effect of variables was studied with Cox proportional hazards models. Thirty-three patients met study inclusion criteria. The median time to diagnosis of HNSCC after transplant was 5.9years. The primary site was oral cavity in 15 patients, oropharynx in 10, larynx in 3, hypopharynx in 2, parotid in 2 and unknown in 1 patient. Eighty-eight percent underwent upfront surgical resection. Of those, sixty-six percent received adjuvant therapy. Six percent of patients had definitive chemoradiation. Treatment was well tolerated and did not lead to graft rejection. The 5-year overall survival rate was 45% and 37% for localized and locally advanced disease respectively. Seventy-five percent of patients with oropharyngeal tumors were HPV-positive and they had better outcomes (5-year overall survival rate of 67%). In multivariate analysis, age ≥60years was a negative predictor of survival (HR 2.7; 95% CI, 1.1–6.5; P=0.03). Patients with post-transplant HNSCC have relatively poor survival and high risk of locoregional and distant recurrence. HPV- positive oropharyngeal tumors continue to have better outcomes in this population.