Date: Sunday, November 8, 2020
Session Title: Systemic Sclerosis & Related Disorders – Clinical Poster III
Session Type: Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Autoantibodies are useful in systemic sclerosis (SSc) for predicting disease course. Some autoantibodies have been associated with a close temporal relationship with cancer. We investigated the association between SSc-specific and SSc-associated autoantibodies and cancer in a national registry.
Methods: Subjects recruited between 2004 and 2019 in a national SSc registry were studied (96% fulfill 2013 ACR/EULAR SSc classification criteria). The exposure was presence of SSc-specific/associated autoantibodies, namely anti-centromere (ACA), -topoisomerase I (ATA), -RNA polymerase 3 (ARNAP), -fibrillarin, -Th/To, -PM-Scl, -Ku, -U1RNP, -NOR90, -Ro52, -RNPC3 and -BICD2. The primary outcome was cancer-associated SSc, defined as cancer occurring within 2, 3 and 5 years of first non-Raynaud SSc manifestation. Univariate logistic regression was used to compare the odds of cancer-associated SSc between the autoantibody subgroups, using anti-centromere as reference. Descriptive statistics were used to compare clinical characteristics of subjects with cancer to those without cancer.
Results: Out of 1698 SSc subjects, 1474 (86.8%) had at least partially available autoantibody data. Mean (SD) age was 55.3 (12.3) years, 87% were female and 59% had a smoking history. Table 1 shows baseline characteristics stratified by autoantibodies. Cancer was diagnosed in 231 (13.6%) subjects. Median (IQR) time between cancer and disease onset was 7.0 (-0.7 to 16.4) years.
Table 2 shows the prevalence of cancer diagnosed within 2, 3 and 5 years of SSc onset, stratified by autoantibodies. Among 207 cancer subjects with available time data, 27 (13.6%), 37 (17.9%) and 58 (28.0%) were diagnosed with cancer within 2, 3 and 5 years of SSc onset. The most frequent types of cancers diagnosed within 5 years were breast (n=13), non-melanoma skin (NMSC, n=12), cervical/uterine (n=9) and hematological (n=8) cancers.
Overall, among all SSc subjects, no autoantibody was predictive of cancer-associated SSc (Table 3). However, ATA-positive subjects were more likely to have a solid cancer excluding NMSC (OR 6.6, 95% CI 1.4-46.4), especially breast cancer (OR 7.9, 95% CI 1.0-159.2), within 2 years of SSc onset. The risk of cancer-associated SSc was not significantly increased among ARNAP-positive subjects, although for solid cancers excluding NMSC, the OR was 5.8 (95% CI 0.56-125.8). Furthermore, subjects positive for at least 3 autoantibodies were more likely to develop cancer within 5 years of SSc onset compared to subjects with 1 or 2 autoantibodies (OR 3.0, 95% CI 1.3-6.1). Subjects who developed cancer within two years of SSc onset were generally younger (51.8 vs 57.9 years) and more frequently had a history of smoking (72% vs 59%) and scleroderma renal crisis (11% vs 3%).
Conclusion: In this study, ATA and overlapping autoantibodies were predictive of cancer-associated SSc for solid cancers excluding NMSC. Breast cancer was the most frequent type of cancer detected within 5 years of first non-Raynaud manifestation. Autoantibodies may help guide the approach to cancer screening. Larger studies are needed to define the risk of cancer-associated SSc within rarer autoantibody subgroups.
To cite this abstract in AMA style:Lazizi S, Hudson M, Baron M, Fritzler M, Hoa S. Associations Between Autoantibodies in Systemic Sclerosis and Cancer in a National Registry [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/associations-between-autoantibodies-in-systemic-sclerosis-and-cancer-in-a-national-registry/. Accessed May 11, 2021.
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