Cancers de novo chez les patients transplantés d’organes solides : faisabilité des traitements oncologiques et facteurs pronostiques

Abstract : Introduction: cancer incidence is increased in transplanted patients compared to general population. Oncologic treatment feasibility and prognosis of these patients remain poorly understood. The aim of this study was to describe treatment feasibility and explore prognosis factors in transplanted patients with de novo cancers. Patients and Methods: this is a monocentric retrospective study including all consecutive cases of de novo cancer in renal and liver transplanted patients based on a systematic research in a database dedicated to transplanted patients from 2000 to 2016. Patients presenting only with non melanic cutaneous tumors were excluded. Univariate and multivariate analyses of prognostic factors associated with survival were done. Results: among 4637 transplanted patients, 209 cases of de novo cancer in 176 different patients with a mean age of 53 years old. Oncologic treatments seemed feasible and not modified compared to general population. Median overall survivals of transplanted patients with localized or advanced cancer were respectively of 166 months (CI95% 100.3-ND) and 8.8 months (CI95% 5.0-47.2). Factors associated with better survival in multivariate analyses were: for localized cancers: young aged (p=0.001), absence of cancer recurrence (p=0.047) and mTOR inhibitors introduction after cancer diagnosis (p=0.012) ; for advanced cancers: lymphoma or sarcoma histologies (p=0.005), optimal treatment according to guidelines (p=0.042) and andmTOR inhibitors introduction after cancer diagnosis (p=0.001). Conclusion: oncologic treatment are feasible in transplanted patients and survival seems equivalent to general population. mTOR inhibitors introduction after cancer diagnosis seems to be an independent specific prognosis factor in transplanted patients with de novo cancer. This observation should be confirmed in prospective study.
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Master Thesis
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Aude Guillemin Jobard. Cancers de novo chez les patients transplantés d’organes solides : faisabilité des traitements oncologiques et facteurs pronostiques. Médecine humaine et pathologie. 2016. ⟨dumas-01618249⟩

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