Cancer risk in systemic lupus: an updated international multi-centre cohort study.
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Bernatsky Sasha, Ramsey-Goldman Rosalind, Labrecque Jeremy, Joseph Lawrence, Boivin Jean-Francois, Petri Michelle, Zoma Asad, Manzi Susan, Urowitz Murray B, Gladman Dafna, Fortin Paul R, Ginzler Ellen, Yelin Edward, Bae Sang-Cheol, Wallace Daniel J, Edworthy Steven, Jacobsen Soren, Gordon Caroline, Dooley Mary Anne, Peschken Christine A, Hanly John G, Alarcón Graciela S, Nived Ola, Ruiz-Irastorza Guillermo, Isenberg David, Rahman Anisur, Witte Torsten, Aranow Cynthia, Kamen Diane L, Steinsson Kristjan, Askanase Anca, Barr Susan, Criswell Lindsey A, Sturfelt Gunnar, Patel Neha M, Senécal Jean-Luc, Zummer Michel, Pope Janet E, Ensworth Stephanie, El-Gabalawy Hani, McCarthy Timothy, Dreyer Lene, Sibley John, St Pierre Yvan, Clarke Ann E
Аннотация
METHODS: A multisite international SLE cohort was linked with regional tumor registries. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers.
RESULTS: Across 30 centres, 16,409 patients were observed for 121,283 (average 7.4) person-years. In total, 644 cancers occurred. Some cancers, notably hematologic malignancies, were substantially increased (SIR 3.02, 95% confidence interval, CI, 2.48, 3.63), particularly non-Hodgkin's lymphoma, NHL (SIR 4.39, 95% CI 3.46, 5.49) and leukemia. In addition, increased risks of cancer of the vulva (SIR 3.78, 95% CI 1.52, 7.78), lung (SIR 1.30, 95% CI 1.04, 1.60), thyroid (SIR 1.76, 95% CI 1.13, 2.61) and possibly liver (SIR 1.87, 95% CI 0.97, 3.27) were suggested. However, a decreased risk was estimated for breast (SIR 0.73, 95% CI 0.61-0.88), endometrial (SIR 0.44, 95% CI 0.23-0.77), and possibly ovarian cancers (0.64, 95% CI 0.34-1.10). The variability of comparative rates across different cancers meant that only a small increased risk was estimated across all cancers (SIR 1.14, 95% CI 1.05, 1.23).
CONCLUSION: These data estimate only a small increased risk in SLE (versus the general population) for cancer over-all. However, there is clearly an increased risk of NHL, and cancers of the vulva, lung, thyroid, and possibly liver. It remains unclear to what extent the association with NHL is mediated by innate versus exogenous factors. Similarly, the etiology of the decreased breast, endometrial, and possibly ovarian cancer risk is uncertain, though investigations are ongoing.