Systemic Lupus Erythematous and Malignancy Risk: A Meta-Analysis

Abstract

BackgroundPilot studies have estimated cancer incidence in patients with systemic lupus erythematous (SLE). However, the results have been inconclusive. To ascertain the correlation between SLE and malignancy more comprehensively and precisely, we conducted a meta-analysis.MethodsPubMed, the Cochrane Library and Embase databases through June 2014, were searched to identify observational studies evaluating the association between SLE and malignancy. The outcomes from these studies were measured as relative risks (RRs). A random or fixed effects model was chosen to calculate the pooled RR according to heterogeneity test. Between-study heterogeneity was assessed by estimating I2 index. Publication bias was assessed by Egger’s test.ResultsA total of 16 papers, including 59,662 SLE patients, were suitable for the meta-analysis. Of these papers, 15 reported RRs for overall malignancy, 12 for non-Hodgkin lymphoma (NHL) and lung cancer, 7 for bladder cancer, 6 for Hodgkin lymphoma (HL) and leukemia, 5 for skin melanoma, and liver and thyroid cancers, 4 for multiple myeloma (MM), and esophageal and vaginal/vulvar cancers and 3 for laryngeal and non-melanoma skin cancers. The pooled RRs were 1.28 (95% CI, 1.17–1.41) for overall cancer, 5.40 (95% CI, 3.75–7.77) for NHL, 3.26(95% CI, 2.17–4.88) for HL, 2.01(95% CI, 1.61–2.52) for leukemia, 1.45(95% CI, 1.04–2.03) for MM, 4.19(95% CI, 1.98–8.87) for laryngeal cancer, 1.59 (95% CI, 1.44–1.76) for lung cancer, 1.86(95% CI, 1.21–2.88) for esophageal cancer, 3.21(95% CI, 1.70–6.05) for liver cancer, 3.67(95% CI, 2.80–4.81) for vaginal/vulvar cancer, 2.11(95% CI, 1.12–3.99) for bladder cancer, 1.51(95% CI, 1.12–2.03) for non-melanoma skin cancer, 1.78(95% CI, 1.35–2.33) for thyroid cancer, and 0.65(95% CI, 0.50–0.85) for skin melanoma. Only the meta-analyses of overall malignancy, NHL, and liver and bladder cancers produced substantial heterogeneity (I2, 57.6% vs 74.3% vs 67.7% vs 82.3%). No apparent publication bias was detected except for NHL studies.ConclusionsOur data support an association between SLE and malignancy, not only demonstrating an increased risk for NHL, HL, leukemia, and some non-hematologic malignancies, including laryngeal, lung, liver, vaginal/vulvar, and thyroid malignancies, but also a reduced risk for skin melanoma. Although an increased risk of MM, and esophageal, bladder and non-melanoma skin cancers was identified from the accumulated data in these studies, this observation requires confirmation.

Cancer risk in cutaneous lupus erythematosus: a population-based cohort study

“…Epidemiological studies have shown that chronic inflammatory diseases, such as RA and SLE, are associated with increased risk of haematological, cutaneous and solidorgan malignancies [1,2]. Even limited autoimmune dermatological conditions, such as psoriasis, are associated with increased risk of both cutaneous and systemic solid-organ malignancies [3].…”

SLE and Non-Hodgkin’s Lymphoma: A Case Series and Review of the Literature

“…The association between lymphoma and SLE has been examined in varied detail and studies have reported an increased incidence of lymphoma in SLE [1–3]. Immune dysregulation coupled with the use of immunosuppression may account for the increased incidence of cancer (and lymphoma) in SLE.…”

“…SLE's association with lymphoma is a well-established phenomenon. A number of studies have reported a higher incidence of lymphoma in the SLE population compared with healthy cohorts [1–3]. The effects of lymphoma development in SLE and its impact on modifying the disease's natural history are a matter of great interest amongst both clinicians and researchers.…”

Méningite lymphocytaire chez une patiente lupique révélant un lymphome cérébral primitif : une association rare

“…Comparativement à la population générale, l'incidence des hémopathies est plus élevée chez les patients atteints de maladie auto-immune, telle que le syndrome de Goujerot-Sjögren, la polyarthrite rhumatoïde ou le LES, avec un odd ratio de lymphome allant de 4,1 à 5,7 selon les études [3,[5][6][7]. La fréquence des lymphomes chez les patients lupiques varie de 3,2 à 11,4 % [7,8]. Le développe-ment spontané de lymphome chez les modèles murins de lupus (souris NZB/NZW) avait déjà été rapporté, suggérant un risque accru de lymphome chez ces patients [9].…”