Incidence of Cancer in a Cohort of Spanish Patients With Systemic Lupus Erythematosus

Hidalgo-Conde, Ana; Liger, Manuel de Haro; Abarca-Costalago, Manuel; Pérez, Martina Álvarez; Valdivielso-Felices, Pedro; González-Santos, Pedro; Fernández‐Nebro, Antonio

doi:10.1016/j.reuma.2012.10.015

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…Whether patients with SLE are at the greater risk of cancer after exposure of immunosuppressive agents remains controversial. On further analysis of the association between cyclophosphamide, mycophenolate mofetil and azathioprine with cancer, we found no association and in keeping with some of the reported literature (Hildalgo-Conde et al, 2013;Dey et al, 2015). Others have demonstrated the association although mainly restricted to cyclophosphamide and cancer (Kang et al, 2010;Dreyer et al, 2011;Bernatsky et al, 2014;Goobie et al, 2015).…”

Section: Discussionsupporting

confidence: 91%

“…Although majority were on low dose immunosuppression at the time of cancer diagnosis, they had a cumulative effect of the immunosuppressive therapy as they had been on SLE treatment for some time. Our group of patients were older than most of the described literature and it could be that they were the right age group for developing cancer like the general population and in keeping with a Spanish study (Hildalgo-Conde et al, 2013). Furthermore, to strengthen this argument is the type of cancer our patients developed were not haematological as commonly reported in the literature but rather cancers seen in the general population (Bjornadal et al, 2002;Bernatsky et al, 2011).…”

Section: Resultssupporting

confidence: 85%

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Malignancy in Systemic Lupus Erythematosus (SLE) Patients

Cader

Yee

Yassin

et al. 2018

Asian Pac J Cancer Prev

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Background: Malignancies are among the leading causes of death in Systemic Lupus Erythematosus (SLE) patients with studies reporting a higher prevalence of malignancy in SLE patients compared to the general population. We wanted to determine the frequency of cancer in a cohort of SLE patients and identify its associated risk factors. Methods: Cross-sectional study involving SLE patients attending the nephrology outpatient clinic, Universiti Kebangsaan Malaysia Medical Centre between January and June 2014. Results: We recruited 228 patients (207 female, 21 male), aged 40.48 ± 12.86 years with mean SLE duration of 11.65 ± 6.46 years. Majority (87%) had lupus nephritis and were in remission with a median SLEDAI score 2 (0, 14). Majority (89%) were on corticosteroid with either a steroid sparing agent like mycophenolate mofetil (15.4%), azathioprine (36.8%) or ciclosporin (15.4%). One hundred and sixty (70.2%) patients were either receiving or had received intravenous cyclophosphamide with median dose of 5,173.6 ± 3,242.4 mg. Seven female patients were diagnosed with cancer during the course of their SLE with 56 (34-78) years being median age at malignancy and SLE duration of 4 (0-12) years. Majority (5/7) had lupus nephritis and all patients a median dose of prednisolone 10 (2.5, 10) mg with 10 (4-24) years of steroids. Two patients had a family history of cancer with majority developing cancer after the diagnosis of SLE. Two patients received intravenous cyclophosphamide prior to the development of cancer for their SLE compared to overall cohort of 160. Three patients had colorectal cancer, 2 had cervical cancer, 1 had breast cancer, and one patient had germ cell tumour and one thyroid cancer. All patients had their cancer successful treated with no signs of recurrence. Conclusion: We found a lower occurrence of cancer in our SLE patients as compared with the reported literature.

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Section: Discussionsupporting

confidence: 91%

Section: Resultssupporting

confidence: 85%

Malignancy in Systemic Lupus Erythematosus (SLE) Patients

Cader

Yee

Yassin

et al. 2018

Asian Pac J Cancer Prev

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“…At present, there is insufficient knowl-| 217 edge regarding the immune system alterations that occur in SLE, changes that may influence cancer onset and/or development (1). Several studies carried out in different countries, races, and ethnic groups show that the global cancer incidence in patients with SLE is higher than in the general population (2)(3)(4)(5)(6)(7). In particular, the cancer standardized incidence ratio (SIR) is higher across virtually all anatomic locations (hematologic, lung, thyroid, hepatobiliary, vulva-vagina, cervix, and pancreas) (2,3,5,6,8,9).…”

Section: Introductionmentioning

confidence: 99%

Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

Cobo‐Ibáñez

Urruticoechea‐Arana

Rúa-Figueroa

et al. 2020

Arthritis Care & Research

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Objective. To estimate the incidence and analyze any cancer-associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone-sensitive (HS) and non-HS cancers.Methods. This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non-HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built.Results. A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15-1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84-2.91]). The SIR in women with HS versus non-HS cancer was 1.02 (95% CI 0.13-1.91) and 1.93 (95% CI 0.98-2.89). In HS versus non-HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin-converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non-HS cancers.Conclusion. Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed. * Values are the number (%) unless indicated otherwise. SLE = systemic lupus erythematosus; SLEDAI = Systemic Lupus Erythematosus Disease Activity Index; IQR = interquartile range; SDI = Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index; ACE = angiotensin-converting enzyme. † The score corresponding to cancer was excluded when calculating the index.

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“…Although the underlying pathophysiology is unknown, there is a debate if dysregulation of the immune system is induced by neoplasia or if the immune reaction against tumorderived antigen promotes the formation of auto-antibodies [41]. Presentation of the lupus-like syndrome can precede the diagnosis of underlying malignancy by at least five years, making the recognition of this paraneoplastic condition a challenging and difficult clinical situation [42][43]. The lupus-like syndrome was frequently associated with hematologic malignancy, such as hairy cell leukemia, non-Hodgkin's lymphoma, and solid tumors (like breast carcinoma, ovarian carcinoma, and lung cancer) [44][45][46][47].…”

Section: Paraneoplastic Raynaud's Phenomenon and Possible Lupus-like Syndromementioning

confidence: 99%

Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review

Cho¹,

Anderson²,

Guevara³

et al. 2021

Cureus

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Paraneoplastic rheumatic disorder (RD) is a disorder that may present before, concurrent with, or after the diagnosis of malignancy. Paraneoplastic RDs are a clinical expression of occult cancer that is not directly related to a tumor or metastasis and manifests as rheumatoid symptoms. The RD is determined by the organ system affected by articular, muscular, cutaneous, vascular, or miscellaneous symptoms. Each case is challenging to diagnose because cancer may present with similar symptoms as a common rheumatic disorder. Of note, the majority of cases have minimal responsiveness or no responsiveness to standard rheumatoid treatment. Therefore, it is imperative to recognize and treat the underlying cancer accordingly. Herein, we present four different diagnostic dilemma cases of RD: case #1 -leukocytoclastic vasculitis and C3 glomerulopathy, case #2 -scleroderma, case #3 -Raynaud's syndrome and possible lupus-like syndrome, and case #4 -inflammatory myositis. Institutional IRB approval was obtained for this case series. We will discuss and review the literature on each topic. In addition, we will mention a review of paraneoplastic rheumatoid arthritis. As rheumatic disease is associated with the use of immune checkpoint inhibitors (ICIs) for cancer treatment, we will briefly discuss some of the most common rheumatic presentations in the setting of these drugs. This case review aims to inform clinicians about the atypical presentation of paraneoplastic RD and to highlight the need for interdisciplinary management between rheumatologists, oncologists, and primary care practitioners.

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Incidence of Cancer in a Cohort of Spanish Patients With Systemic Lupus Erythematosus

Cited by 12 publications

References 22 publications

Malignancy in Systemic Lupus Erythematosus (SLE) Patients

Malignancy in Systemic Lupus Erythematosus (SLE) Patients

Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review

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