The Incidence and Predictors of Solid- and Hematological Malignancies in Patients with Giant Cell Arteritis: A Large Real-World Database Study

Abstract

Background: The association between giant cell arteritis (GCA) and malignancies had been widely investigated with studies reporting conflicting results. Therefore, in this study, we aimed to investigate this association using a large nationwide electronic database. Methods: This study was designed as a retrospective cohort study including GCA patients first diagnosed between 2002–2017 and age, sex and enrollment time-matched controls. Follow-up began at the date of first GCA-diagnosis and continued until first diagnosis of malignancy, death or end of study follow-up. Results: The study enrolled 7213 GCA patients and 32,987 age- and sex-matched controls. The mean age of GCA diagnosis was 72.3 (SD 9.9) years and 69.1% were women. During the follow-up period, 659 (9.1%) of GCA patients were diagnosed with solid malignancies and 144 (2.0%) were diagnosed with hematologic malignancies. In cox-multivariate-analysis the risk of solid- malignancies (HR = 1.12 [95%CI: 1.02–1.22]), specifically renal neoplasms (HR = 1.60 [95%CI: 1.15–2.23]) and sarcomas (HR = 2.14 [95%CI: 1.41–3.24]), and the risk of hematologic malignancies (HR = 2.02 [95%CI: 1.66–2.47]), specifically acute leukemias (HR = 1.81 [95%CI: 1.06–3.07]), chronic leukemias (HR = 1.82 [95%CI: 1.19–2.77]), Hodgkin’s lymphomas (HR = 2.42 [95%CI: 1.12–5.20]), non-Hodgkin’s-lymphomas (HR = 1.66: [95%CI 1.21–2.29]) and multiple myeloma(HR = 2.40 [95%CI: 1.63–3.53]) were significantly increased in GCA patients compared to controls. Older age at GCA-diagnosis (HR = 1.36 [95%CI: 1.25–1.47]), male-gender (HR = 1.46 [95%CI: 1.24–1.72]), smoking (HR = 1.25 [95%CI: 1.04–1.51]) and medium-high socioeconomic status (HR = 1.27 [95%CI: 1.07–1.50]) were independently associated with solid malignancy while age (HR = 1.47 [95%CI: 1.22–1.77]) and male-gender (HR = 1.61 [95%CI: 1.14–2.29]) alone were independently associated with hematologic- malignancies. Conclusion: our study demonstrated higher incidence of hematologic and solid malignancies in GCA patients. Specifically, leukemia, lymphoma, multiple myeloma, kidney malignancies, and sarcomas. Age and male gender were independent risk factors for hematological malignancies among GCA patients, while for solid malignancies, smoking and SES were risk factors as well.

Association of fibromyalgia with cancerous and non-cancerous gastrointestinal comorbidities: a cross-sectional study

“…The diagnoses are documented by either a primary care physician or specialist using the International Classification of Diseases (ICD). The data is systematically verified and was found to be highly creditable in previous studies (11,12), including study that investigated the association between FM and diabetes mellitus (13). The Ethics Committee of the CHS approved this study and waived the requirement for informed consent.…”

“…Moreover, this study lacks information regarding temporality, and the information concerning the criteria for diagnosing the various diseases was unavailable. However CHS data are systematically verified and was found to has high validity in earlier studies (11)(12)(13).…”

Mimickers of Large Vessel Giant Cell Arteritis

“…A retrospective study reported a higher risk of solid malignancy (Hazard Ratio (HR) = 1.2) and hematological malignancy in GCA compared to a control population. Higher age at diagnosis and male gender were associated with malignancy [86]. By contrast, other studies did not confirm these results [87].…”

Low incidence of malignancy in patients with suspected polymyalgia rheumatica or giant cell arteritis, examined with FDG-PET/CT

“…Ji et al and Muller et al found an increased risk of cancer within the first 6 to 12 months after the diagnosis of PMR and GCA in large-scale register-based studies ( 20 , 21 ). Similarly, Dar et al and Bellan et al both found an increased risk of cancer in patients with GCA and PMR, respectively, and both studies found that male sex and older age were independent predictors for malignancy ( 16 , 22 ). Conversely, other studies, such as those from Pfeifer et al and Hill et al have not been able to confirm a higher risk of malignancy in patients diagnosed with PMR/GCA ( 23 , 24 ).…”