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Malignancies in patients with antineutrophil cytoplasmic antibody-associated vasculitis : A population-based cohort study

Heijl, Caroline LU ; Westman, Kerstin LU ; Höglund, Peter LU and Mohamma, Aladdin J. (2020) In Journal of Rheumatology 47(8). p.1229-1237
Abstract

Objective. Patients with ANCA-associated vasculitides (AAV) exhibit higher rates of malignancy than the general population. We assessed whether the cancer risk is increased in a well-characterized population-based cohort of AAV in southern Sweden, followed for a median time of 8 years. Methods. With case record review, the outcomes and malignancy development in a cohort of 195 patients with AAV [granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA] diagnosed between 1997 and 2010 were assessed. The patients were followed until death or December 31, 2015. The age- and sex-standardized incidence ratios (SIR) were estimated using the Swedish population data as a reference. Results. During the observation... (More)

Objective. Patients with ANCA-associated vasculitides (AAV) exhibit higher rates of malignancy than the general population. We assessed whether the cancer risk is increased in a well-characterized population-based cohort of AAV in southern Sweden, followed for a median time of 8 years. Methods. With case record review, the outcomes and malignancy development in a cohort of 195 patients with AAV [granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA] diagnosed between 1997 and 2010 were assessed. The patients were followed until death or December 31, 2015. The age- and sex-standardized incidence ratios (SIR) were estimated using the Swedish population data as a reference. Results. During the observation period of about 1500 person-years, we found 60 cancers in 52 of the 195 patients. SIR (95% CI) was 2.8 (2.1-3.6) for cancers at all sites, 1.8 (1.3-2.5) for all cancers excluding squamous cell carcinoma (SCC), 12.9 (8.4-18.8) for SCC, 4.3 (1.4-10.0) for bladder cancer, and 7.0 (1.4-20.5) for pancreatic cancer. Cumulative doses of cyclophosphamide (CYC) < 10 g were not associated with higher incidence of cancers other than SCC (SIR 1.63, 95% CI 0.8-2.9). Conclusion. In contrast to previous publications assessing malignancy risk in patients with AAV, we show in this population-based cohort of patients a persistent increased risk for overall malignancy, bladder cancer, and pancreatic cancer as well as a markedly increased risk for SCC. There was no increase in incidence of cancers other than SCC for those treated with < 10 g CYC.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antineutrophil cytoplasmic antibodies, Granulomatosis with polyangiitis, Population, Vasculitis
in
Journal of Rheumatology
volume
47
issue
8
pages
9 pages
publisher
Journal of Rheumatology Publishing Company Limited
external identifiers
  • scopus:85079864470
  • pmid:31474595
ISSN
0315-162X
DOI
10.3899/jrheum.181438
language
English
LU publication?
yes
id
577e95aa-c7d3-4e99-9162-58e76f5433a1
date added to LUP
2021-01-08 14:13:46
date last changed
2024-06-27 05:24:31
@article{577e95aa-c7d3-4e99-9162-58e76f5433a1,
  abstract     = {{<p>Objective. Patients with ANCA-associated vasculitides (AAV) exhibit higher rates of malignancy than the general population. We assessed whether the cancer risk is increased in a well-characterized population-based cohort of AAV in southern Sweden, followed for a median time of 8 years. Methods. With case record review, the outcomes and malignancy development in a cohort of 195 patients with AAV [granulomatosis with polyangiitis (GPA), microscopic polyangiitis, and eosinophilic GPA] diagnosed between 1997 and 2010 were assessed. The patients were followed until death or December 31, 2015. The age- and sex-standardized incidence ratios (SIR) were estimated using the Swedish population data as a reference. Results. During the observation period of about 1500 person-years, we found 60 cancers in 52 of the 195 patients. SIR (95% CI) was 2.8 (2.1-3.6) for cancers at all sites, 1.8 (1.3-2.5) for all cancers excluding squamous cell carcinoma (SCC), 12.9 (8.4-18.8) for SCC, 4.3 (1.4-10.0) for bladder cancer, and 7.0 (1.4-20.5) for pancreatic cancer. Cumulative doses of cyclophosphamide (CYC) &lt; 10 g were not associated with higher incidence of cancers other than SCC (SIR 1.63, 95% CI 0.8-2.9). Conclusion. In contrast to previous publications assessing malignancy risk in patients with AAV, we show in this population-based cohort of patients a persistent increased risk for overall malignancy, bladder cancer, and pancreatic cancer as well as a markedly increased risk for SCC. There was no increase in incidence of cancers other than SCC for those treated with &lt; 10 g CYC.</p>}},
  author       = {{Heijl, Caroline and Westman, Kerstin and Höglund, Peter and Mohamma, Aladdin J.}},
  issn         = {{0315-162X}},
  keywords     = {{Antineutrophil cytoplasmic antibodies; Granulomatosis with polyangiitis; Population; Vasculitis}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1229--1237}},
  publisher    = {{Journal of Rheumatology Publishing Company Limited}},
  series       = {{Journal of Rheumatology}},
  title        = {{Malignancies in patients with antineutrophil cytoplasmic antibody-associated vasculitis : A population-based cohort study}},
  url          = {{http://dx.doi.org/10.3899/jrheum.181438}},
  doi          = {{10.3899/jrheum.181438}},
  volume       = {{47}},
  year         = {{2020}},
}