Cancer complicating systemic lupus erythematosus – a dichotomy emerging from a nested case-control study

Objectives We determined whether any individual cancers are increased or decreased in a cohort of 595 patients with systemic lupus erythematosus (SLE) followed for up to 32 years at the University College London Hospitals Lupus Clinic, looking for any associated clinical or serological factors and t...

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Bibliographic Details
Published in:Lupus 2013-08, Vol.22 (9), p.919-927
Main Authors: Dey, D, Kenu, E, Isenberg, DA
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Breast cancer
Case-Control Studies
Cervical cancer
Child
Child, Preschool
Cohort analysis
Correspondence
Disease
Drug dosages
Ethnicity
Fatalities
Female
Follow-Up Studies
Hospitals
Humans
Incidence
Infant
Lupus
Lupus Erythematosus, Systemic - complications
Lymphoma
Male
Medical diagnosis
Medical prognosis
Medical records
Middle Aged
Multivariate Analysis
Neoplasms - epidemiology
Neoplasms - pathology
Prognosis
Prostate
Retrospective Studies
Rheumatology
Risk
Survival Rate
University colleges
Young Adult
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Summary:Objectives We determined whether any individual cancers are increased or decreased in a cohort of 595 patients with systemic lupus erythematosus (SLE) followed for up to 32 years at the University College London Hospitals Lupus Clinic, looking for any associated clinical or serological factors and the prognosis after cancer diagnosis. Methods We undertook a careful retrospective review of the medical records and identified all individuals diagnosed with cancer. For controls, we selected three other patients in the cohort who had not developed cancer, carefully matched for age, sex, ethnicity and disease duration, to determine if any obvious differences emerged in a nested case-control design. Results Thirty-three patients developed cancer after being diagnosed with SLE. There was a statistically insignificant small increase in overall cancer risk, standardized incidence ratios (SIRs) 1.05 (95% CI 0.52–1.58) and increased SIRs for cervical, prostate, anal and pancreatic cancers and reduction in breast cancer SIRs. Haematological and musculoskeletal manifestations, anticardiolipin and antithyroid globulin antibodies were found to be positively associated with cancer risk in multivariate analysis. There was no drug, dose or duration was associated with cancer risk. There was a reduction in survival with a cancer fatality rate of 84.2% (p 
ISSN:0961-2033
1477-0962
DOI:10.1177/0961203313497118