DIFFERENCES IN SURVIVAL PATTERNS BETWEEN TRANSPLANT RECIPIENTS AND GENERAL POPULATION PATIENTS DEVELOPING DE NOVO COLORECTAL CANCER

Abstract

P849 Despite recent data indicating that the incidence of colorectal cancer (CRC) is higher in transplant (TXP) recipients compared to the general population, the effects of immunosuppression on CRC are not well defined. Methods: We examined all transplant recipients with de novo CRC. Analysis of patient demographics, tumor stage, tumor location, cadaveric vs living related (LR) renal TXP grafts, and immunosuppression was performed. Diagnosis age and survival rate were compared to CRC patients in the SEER National Cancer Institute (NCI) database. Results: 150 TXP recipients with de novo CRC were identified, among which were 93 (62%) kidney, 29 (19.3%) heart, 27 (18%) liver, and 1 (0.7%) lung recipient. Median age of TXP was 54 years, compared to a median age of 72 years for patients in the SEER NCI database; median age at diagnosis of CRC was 59 years. Time from transplant to diagnosis of CRC relative to sex, race, tumor location, or tumor stage was not significant. Recipients of cadaveric renal TXP grafts were compared to those who received LR renal grafts. The results indicated a significantly shorter time from TXP to diagnosis of CRC (63.4±7.3 months vs. 103.5±19.2; p=0.023 respectively), with no significant difference in survival. However, compared to patients from the SEER NCI database, recipients with Duke’s A through C stage disease were noted to experience a significant decrease in 5-year survival (Table 1).FigureConclusions: The early age at presentation of CRC in transplant recipients suggests that the development of de novo CRC may be effected by the degree of immunosuppression. Decreased 5-year survival rates, occurring at younger (median) diagnosis ages in TXP recipients with CRC, suggest that chronic immunosuppression may result in more aggressive tumor biology. Further study may indicate a post transplant CRC screening program with closer interval followup may be beneficial to these patients, as well as more aggressive reduction in immunosuppression.