Survival rates of cancer patients with and without rheumatic disease: a retrospective cohort analysis

Abstract

BackgroundTo compare the outcomes of gastric, colon, lung, and breast cancer patients with and without rheumatic diseases (RD).MethodsThis retrospective study compared the cancer survival rates of a cohort of 122 cancer patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), dermatomyositis/polymyositis (DM/PM), or systemic sclerosis with that of a cohort of 366 age-, sex-, and, cancer type-matched patients without RD who received medical care from 2000 to 2014. Staging, comorbidities, and functional status were ascertained. Survival was compared using the Kaplan-Meier method. Relative risk of death was estimated as a hazard ratio (HR) using Cox regression analysis.ResultsThe mean age of the RD patients at the time of cancer diagnosis was 58.7 ± 11.5 years. The overall survival rate of gastric cancer patients did not differ between the cohorts. The survival of lung or breast cancer was worse in patients with RA or DM/PM than in those without RD (all, p < 0.05). After adjusting for cancer stage, comorbidity index, performance status and age at the time of cancer diagnosis (as well as interstitial lung disease for lung cancer group), the mortality rate among lung cancer patients with RA was significantly higher (HR, 1.81; 95 % CI, 1.03–3.18) than that of lung cancer patients without RD, whereas SSc was associated with decreased mortality of lung cancer (HR, 0.16; 95 % CI, 0.04–0.58). DM/PM were associated with increased mortality of breast cancer patients (HR, 297.39; 95 % CI, 4.24–20842.33).ConclusionsRA and DM/PM seemed to be associated with a higher mortality in patients with lung or breast cancers, whereas SSc seemed to be associated with decreased mortality in patients with lung cancer. It is warranted to explore the survival effect of tailored cancer treatments according to specific RD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2444-5) contains supplementary material, which is available to authorized users.

The Prevalence of Systemic Rheumatic Diseases Among Breast Cancer Patients and Its Relationship With Survival

“…24 In a recent retrospective study on 122 colon, gastric, lung, and BC patients with several SRDs including RA, dermatomyositis/ polymyositis (DM/PM), SLE, SSc, patients with RA and DM/PM were found to be associated with higher mortality in patients with lung cancer or BC. 25 In another study from Sweden on 1,411,163 cancer patients, patients with RA were noted to have worse prognosis, with hazard ratios of 1.29 and 1.31 for cause-specific and overall survival, respectively, compared to all cancer patients without RA. 26 However, our study did not disclose any significant difference in terms of five-year overall survival and diseasefree survival between RA patients and patients without SRDs.…”

Risk of breast cancer before and after rheumatoid arthritis, and the impact of hormonal factors

“…However, the negative association between RA and breast cancer was described in studies conducted before mammographic screening was mainstay 34 35. Moreover, since the assessment of RA risk after breast cancer is, by definition, an assessment among breast cancer survivors, we cannot exclude that breast cancer among would-be patients with RA could have a worse prognosis irrespective of cancer stage 36 37…”

Enhancement of cancer invasion and growth via the C5a‑C5a receptor system: Implications for cancer promotion by autoimmune diseases and association with cervical cancer invasion

“…Thus, the endogenous C5a in the reaction site acted on both cancer cells and the cancer microenvironment, synergistically promoting cancer. The cancer promotion by the Arthus reaction suggests that C5a generation may be an underlying mechanism for the poor prognosis of the cancer patients with autoimmune diseases (2–4), particularly patients with C5aR-positive cancers. The promotion of lung nodule formation of intravenously injected C5aR-positive cancer cells (Fig.…”

“…Autoimmune diseases are caused by immune complex-induced activation of the complement system and subsequent inflammation, both of which injure tissues (1). Recent studies have revealed an association between autoimmune diseases, including rheumatoid arthritis and thyroiditis, and worse survival in patients with lung, breast, or thyroid cancers (2–4); however, the underlying mechanism is still unclear.…”

“…The Arthus reaction is a model of autoimmune diseases and caused by immune complex-triggered complement activation (24,25). To explore the mechanism underlying the poor prognosis of cancer patients with autoimmune diseases (2–4), the effect of the Arthus reaction on cancer invasion and growth, and MDSC recruitment was investigated using wild-type mice and syngeneic cancer cells with or without C5aR expression. The C5a-C5aR system was further examined in lung nodules formed by cancer cells intravenously injected into mice and in uterine cervical cancer invasion using clinically obtained tissue samples of the cancer.…”