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Cancer risk in a large inception SLE cohort: Effects of demographics, smoking, and medications.
Bernatsky, Sasha; Ramsey-Goldman, Rosalind; Urowitz, Murray B; Hanly, John G; Gordon, Caroline; Petri, Michelle A; Ginzler, Ellen M; Wallace, Daniel J; Bae, Sang-Cheol; Romero-Diaz, Juanita; Dooley, Mary Anne; Peschken, Christine A; Isenberg, David A; Rahman, Anisur; Manzi, Susan; Jacobsen, Soren; Lim, S Sam; van Vollenhoven, Ronald; Nived, Ola; Kamen, Diane L; Aranow, Cynthia; Ruiz-Irastorza, Guillermo; Sanchez-Guerrero, Jorge; Gladman, Dafna D; Fortin, Paul R; Alarcón, Graciela S; Merrill, Joan T; Kalunian, Kenneth C; Ramos-Casals, Manuel; Steinsson, Kristjan; Zoma, Asad; Askanase, Anca; Khamashta, Munther A; Bruce, Ian; Inanc, Murat; Clarke, Ann E.
Afiliação
  • Bernatsky S; Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, University McGill, Montreal, Quebec, Canada.
  • Ramsey-Goldman R; Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
  • Urowitz MB; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
  • Hanly JG; Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
  • Gordon C; Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
  • Petri MA; Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Ginzler EM; Department of Medicine, SUNY Downstate Medical Centre, Brooklyn, NY, USA.
  • Wallace DJ; Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
  • Bae SC; Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
  • Romero-Diaz J; Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico.
  • Dooley MA; Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA.
  • Peschken CA; University of Manitoba, Winnipeg, Manitoba, Canada.
  • Isenberg DA; Centre for Rheumatology, Department of Medicine, University College London, London, UK.
  • Rahman A; Centre for Rheumatology, Department of Medicine, University College London, London, UK.
  • Manzi S; Lupus Centre of Excellence, Allegheny Health Network, Pittsburgh, PA, USA.
  • Jacobsen S; Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
  • Lim SS; Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA.
  • van Vollenhoven R; Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, Holland, Netherlands.
  • Nived O; Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden.
  • Kamen DL; Medical University of South Carolina, Charleston, South Carolina, USA.
  • Aranow C; Feinstein Institute for Medical Research, Manhasset, NY, USA.
  • Ruiz-Irastorza G; Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
  • Sanchez-Guerrero J; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
  • Gladman DD; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
  • Fortin PR; Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Canada.
  • Alarcón GS; Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
  • Merrill JT; Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
  • Kalunian KC; UCSD School of Medicine, La Jolla, CA, USA.
  • Ramos-Casals M; Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
  • Steinsson K; Department of Rheumatology, Center for Rheumatology Research Fossvogur, Landspitali University Hospital, Reykjavik, Iceland.
  • Zoma A; Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
  • Askanase A; Department of Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York, USA.
  • Khamashta MA; Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK.
  • Bruce I; Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
  • Inanc M; Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
  • Clarke AE; Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Artigo em Inglês | MEDLINE | ID: mdl-32813314
ABSTRACT

OBJECTIVE:

To assess cancer risk factors in incident SLE.

METHODS:

Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (over-all risk, and most common cancers) included demographics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and adjusted mean SLE Disease Activity Index-2K.

RESULTS:

Among 1668 patients (average 9 years follow-up), 65 cancers occurred 15 breast, 10 non-melanoma skin, seven lung, six hematological, six prostate, five melanoma, three cervical, three renal, two each gastric, head and neck, and thyroid, and one each rectal, sarcoma, thymoma, and uterine cancers. Half of cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated over-all cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively and anti-malarial drugs were negatively associated. Anti-malarial drugs and higher disease activity were also negatively associated with non-melanoma skin cancer (NMSC) risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with NMSC risk.

CONCLUSIONS:

Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and NMSC. Antimalarials were negatively associated with breast cancer and NMSC risk. SLE activity was associated positively with hematologic cancer and negatively with NMSC. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.
Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Neglicenciadas Tema em saúde: Malária Base de dados: MEDLINE Tipo de estudo: Estudo de etiologia / Estudo observacional / Estudo prognóstico / Fatores de risco Idioma: Inglês Assunto da revista: Reumatologia Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Canadá

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Texto completo: Disponível Coleções: Bases de dados internacionais Contexto em Saúde: Doenças Neglicenciadas Tema em saúde: Malária Base de dados: MEDLINE Tipo de estudo: Estudo de etiologia / Estudo observacional / Estudo prognóstico / Fatores de risco Idioma: Inglês Assunto da revista: Reumatologia Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Canadá