Sebaceous Carcinoma Incidence and Survival Among Solid Organ
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Risk of sebaceous carcinoma (SC), a rare skin cancer associated with Muir-Torre syndrome, is elevated among solid organ transplant recipients (SOTRs). However, population studies evaluating this association and assessing survival for posttransplant cases are lacking, and further understanding of SC epidemiology in this immunosuppressed population could provide etiologic and clinical insights.

To assess SC incidence and patient survival after solid organ transplantation a cohort study was conducted from January 1, 1987, to December 31, 2017. Altogether, these registries account for approximately 46% of all US transplants. Standardized incidence ratios (SIRs) comparing SC incidence among SOTRs to the general population were calculated. Incidence rate ratios (IRRs) comparing SC risk between SOTR subgroups were calculated using multivariate Poisson regression. Cox regression was used to compare overall survival between SC cases in SOTRs and other individuals.

A total of 326282 transplant procedures were performed for 301075 patients (126550 aged 0-44 years); (82 394 aged 45-54 years); (82082 aged 55-64 years); (35256 aged more than 65 years); (201354 male patients, 202557 White patients).

A total of 102 SCs were diagnosed in 301?075 SOTRs, corresponding to a 25-fold increased incidence.
--Incidence was especially elevated among lung recipients (SIR, 47.7) and after a posttransplant diagnosis of cutaneous squamous cell carcinoma (SIR, 104.0).
--Among SOTRs, factors independently associated with SC risk included male sex (IRR, 2.46), race/ethnicity (non-Hispanic Black vs non-Hispanic White, IRR, 0.28), older age (IRR, 7.85, more than 65 vs 0-44 years), use of thymoglobulin induction (IRR, 1.82), posttransplant cutaneous squamous cell carcinoma (IRR, 4.60), and longer time since transplant (IRR, 8.40; more than 10 vs 0-1.9 years).

Muir-Torre syndrome–associated cancers were rare among both SOTRs and others with SC (3.3%-4.1%). Among patients with SC, prior transplantation was associated with increased overall mortality (adjusted hazard ratio, 2.09), although few deaths were attributed to SC (4 of 92 SOTRs; 235 of 3585 non-SOTRs [6.6%]).

Conclusively, among SOTRs, results of this large cohort study suggests that SC was associated with measures of immunosuppression, and overall survival was worse than for other patients with SC. Findings also suggest a possible role for UV radiation in carcinogenesis.