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Hormonal Dependence and Cancer in Systemic Lupus Erythematosus
Author(s) -
CoboIbáñez Tatiana,
UrruticoecheaArana Ana,
RúaFigueroa Iñigo,
MartínMartínez María A.,
OvallesBonilla Juan Gabriel,
Galindo María,
CalvoAlén Jaime,
Olivé Alejandro,
FernándezNebro Antonio,
MenorAlmagro Raúl,
Tomero Eva,
Horcada Loreto,
UriarteItzazelaia Esther,
MartínezTaboada Víctor M.,
Andreu José Luis,
Boteanu Alina,
Narváez Javier,
Bohorquez Cristina,
Montilla Carlos,
Santos Gregorio,
HernándezCruz Blanca,
Vela Paloma,
Salgado Eva,
Freire Mercedes,
HernándezBeriain José Ángel,
DíezÁlvarez Elvira,
Expósito Lorena,
FernándezBerrizbeitia Olaia,
VellosoFeijoo María Luisa,
IbáñezBarceló Mónica,
LozanoRivas Nuria,
Bonilla Gema,
Moreno Mireia,
Raya Enrique,
QuevedoVila Víctor Eliseo,
VázquezRodríguez Tomas Ramón,
IbáñezRuan Jesús,
MuñozFernández Santiago,
SánchezAlonso Fernando,
PegoReigosa José María
Publication year - 2020
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.24068
Subject(s) - medicine , cancer , incidence (geometry) , breast cancer , odds ratio , prostate cancer , rheumatology , confidence interval , cohort , endometrial cancer , oncology , gastroenterology , physics , optics
Objective To estimate the incidence and analyze any cancer‐associated factors in patients with systemic lupus erythematosus ( SLE ), differentiating between hormone‐sensitive ( HS ) and non‐ HS cancers. Methods This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post‐ SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non‐ HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built. Results A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI ] 1.15–1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84–2.91]). The SIR in women with HS versus non‐ HS cancer was 1.02 (95% CI 0.13–1.91) and 1.93 (95% CI 0.98–2.89). In HS versus non‐ HS cancers, SLE diagnostic age (odds ratio [ OR ] 1.04 [ P = 0.002] versus 1.04 [ P = 0.019]), and period of disease evolution ( OR 1.01 [ P < 0.001] versus 1.00 [ P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index ( OR 1.27 [ P = 0.022]) and angiotensin‐converting enzyme ( ACE ) inhibitor prescriptions ( OR 2.87 [ P = 0.048]) were associated with non‐ HS cancers. Conclusion Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non‐ HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed.