PMID- 33816146
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210406
IS  - 2220-3230 (Print)
IS  - 2220-3230 (Electronic)
IS  - 2220-3230 (Linking)
VI  - 11
IP  - 3
DP  - 2021 Mar 18
TI  - Risk prediction model for cutaneous squamous cell carcinoma in adult cardiac 
      allograft recipients.
PG  - 54-69
LID - 10.5500/wjt.v11.i3.54 [doi]
AB  - BACKGROUND: Heart transplant recipients are at higher risk of developing skin 
      cancer than the general population due to the long-term immunosuppression 
      treatment. Cancer has been reported as one of the major causes of morbidity and 
      mortality for patients after heart transplantation. Among different types of skin 
      cancers, cutaneous squamous cell carcinoma (cSCC) is the most common one, which 
      requires timely screening and better management. AIM: To identify risk factors 
      and predict the incidence of cSCC for heart transplant recipients. METHODS: We 
      retrospectively analyzed adult heart transplant recipients between 2000 and 2015 
      extracted from the United Network for Organ Sharing registry. The whole dataset 
      was randomly divided into a derivation set (80%) and a validation set (20%). Uni- 
      and multivariate Cox regression were done to identify significant risk factors 
      associated with the development of cSCC. Receiver operating charac-teristics 
      curves were generated and area under the curve (AUC) was calculated to assess the 
      accuracy of the prediction model. Based on the selected risk factors, a risk 
      scoring system was developed to stratify patients into different risk groups. A 
      cumulative cSCC-free survival curve was generated using the Kaplan-Meier method 
      for each group, and the log-rank test was done to compare the inter-group cSCC 
      rates. RESULTS: There were 23736 heart-transplant recipients during the study 
      period, and 1827 of them have been reported with cSCC. Significant predictors of 
      post-transplant cSCC were older age, male sex, white race, recipient and donor 
      human leukocyte antigen (HLA) mismatch level, malignancy at listing, diagnosis 
      with restrictive myopathy or hypertrophic myopathy, heart re-transplant, and 
      induction therapy with OKT3 or daclizumab. The multivariate model was used to 
      predict the 5-, 8- and 10-year incidence of cSCC and respectively provided AUC of 
      0.79, 0.78 and 0.77 in the derivation set and 0.80, 0.78 and 0.77 in the 
      validation set. The risk scoring system assigned each patient with a risk score 
      within the range of 0-11, based on which they were stratified into 4 different 
      risk groups. The predicted and observed 5-year probability of developing cSCC 
      match well among different risk groups. In addition, the log-rank test indicated 
      significantly different cSCC-free survival across different groups. CONCLUSION: A 
      risk prediction model for cSCC among heart-transplant recipients has been 
      generated for the first time. It offers a c-statistic of >/= 0.77 in both 
      derivation and validation sets.
CI  - (c)The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights 
      reserved.
FAU - Nair, Nandini
AU  - Nair N
AD  - Division of Cardiology, Department of Internal Medicine, Texas Tech Health 
      Sciences Center, Lubbock, TX 79430, United States. nandini.nair@ttuhsc.edu.
FAU - Hu, Zhiyong
AU  - Hu Z
AD  - Department of Industrial, Manufacturing and Systems Engineering, Texas Tech 
      University, Lubbock, TX 79409, United States.
FAU - Du, Dongping
AU  - Du D
AD  - Department of Industrial, Manufacturing and Systems Engineering, Texas Tech 
      University, Lubbock, TX 79409, United States.
FAU - Gongora, Enrique
AU  - Gongora E
AD  - Department of Cardiothoracic Surgery, University of Alabama at Birmingham, 
      Birmingham, AL 35233, United States.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - World J Transplant
JT  - World journal of transplantation
JID - 101608356
PMC - PMC8009060
OTO - NOTNLM
OT  - Cox proportional hazard model
OT  - Cutaneous squamous cell carcinoma
OT  - Heart transplantation
OT  - Mortality outcomes
OT  - Risk assessment
OT  - Squamous cell carcinoma
COIS- Conflict-of-interest statement: None of the authors have any conflict of interest 
      with respect to this research work.
EDAT- 2021/04/06 06:00
MHDA- 2021/04/06 06:01
PMCR- 2021/03/18
CRDT- 2021/04/05 06:07
PHST- 2020/09/06 00:00 [received]
PHST- 2020/12/25 00:00 [revised]
PHST- 2021/02/19 00:00 [accepted]
PHST- 2021/04/05 06:07 [entrez]
PHST- 2021/04/06 06:00 [pubmed]
PHST- 2021/04/06 06:01 [medline]
PHST- 2021/03/18 00:00 [pmc-release]
AID - 10.5500/wjt.v11.i3.54 [doi]
PST - ppublish
SO  - World J Transplant. 2021 Mar 18;11(3):54-69. doi: 10.5500/wjt.v11.i3.54.