Lung Transplantation for Lung Cancer: a Systematic Review of the Literature.

OBJECTIVE: Lung transplant (LTx) is an accepted treatment for end-stage pulmonary failure. A small proportion of explanted lungs harbor incidentally identified non-small cell lung cancers (NSCLC). We review the literature on studies assessing LTx patients found to have NSCLC lung cancer in their explanted lungs, and perform a pooled analysis of outcomes.

METHODS: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched. We included studies assessing outcomes of patients with incidentally identified NSCLC following LTx, or following LTx for diffuse lepidic adenocarcinoma as a primary indication.

RESULTS: A total of 1,404 articles were reviewed. 17 eligible studies were identified: 14 studies on incidental NSCLC (N=169), 4 on diffuse lepidic adenocarcinoma (N=70). Overall survival for patients with incidentally identified lung cancer at 1-year, 3-years, and 5-years was 60.8% (95%CI 43.7 - 77.9%, I2 = 81.8%), 25.5% (95%CI 1.6 - 49.5%, I2 = 93.6%), and 23.0% (95%CI 2.0 - 44.0%, I2 = 92.0%) respectively. When restricted to those with earlier stage disease, those with stage I or II NSCLC had better 1-year, 3-year, and 5-year OS at 72.7% (95%CI 57.2 - 88.2%, I2 = 67.3%), 41.6% (95%CI 14.0 - 69.1%, I2 = 89.1%), and 34.5% (95%CI 8.1 - 61.0%, I2 = 89.8%) respectively. A sensitivity analysis limited to stage I showed 1-year, 3-year, and 5-year survival of 73.0% (95%CI 56.3 - 89.7%), 40.4% (95%CI 110.3 - 70.6%), and 35.4% (95%CI 6.2 - 64.5%) respectively. The 4 studies on diffuse lepidic adenocarcinoma were too heterogeneous for pooled analysis.

CONCLUSIONS: We present a review and pooled analysis examining survival following LTx with incidentally identified NSCLC. Patients with earlier stage incidentally explanted NSCLC had better survival outcomes. Overall survival in the Stage I population approximates that of LTx without incidental NSCLC.