ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1606

Cancer in an SLE Inception Cohort: Smoking May out-Perform Tumor Markers As a Risk Predictor

Sasha Bernatsky1, Murray Urowitz2, John G Hanly3, Ann E. Clarke4, Marvin J. Fritzler5, Caroline Gordon6, Juanita Romero-Diaz7, Graciela S. Alarcón8, Sang-Cheol Bae9, Michelle Petri10, Joan T. Merrill11, Daniel J. Wallace12, Paul R. Fortin13, Dafna D Gladman14, David A. Isenberg15, Anisur Rahman16, Susan Manzi17, Ola Nived18, Gunnar K. Sturfelt19, Christine A. Peschken20, Jorge Sanchez-Guerrero21, Guillermo Ruiz-Irastorza22, Cynthia Aranow23, Ronald F van Vollenhoven24, Asad Zoma25, Kristján Steinsson26, Munther A Khamashta27, Ellen M. Ginzler28, Anca Askanase29, Kenneth C. Kalunian30, Mary Anne Dooley31, S. Sam Lim32, Diane L. Kamen33, Søren Jacobsen34, Manuel Ramos-Casals35, Murat Inanc36, Jennifer LF Lee37 and Rosalind Ramsey-Goldman38, 1Divisions of Rheumatology and Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, 2Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 3Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada, 4Division of Rheumatology, University of Calgary, Calgary, AB, Canada, 5Medicine, University of Calgary, Calgary, AB, Canada, 6Rheumatology Research Group, Institute of Inflammation and Ageing,, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom, 7Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico, 8University of Alabama at Birmingham, Birmingham, AL, 9Department of Rhematology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, Republic of (South), 10Medicine (Rheumatology), Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA, Baltimore, MD, 11Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 12Rheumatology, Cedars-Sinai Medical Center, Beverly Hills, CA, 13Université Laval, CHU de Québec, Québec, QC, Canada, 14Department of Medicine, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, 15Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom, 16Rayne Institute, Centre for Rheumatology Research, UCL Division of Medicine, London, United Kingdom, 17Medicine, Allegheny Health Network, Pittsburgh, PA, 18Department of Rheumatology, University Hospital, Lund, Sweden, 19Department of Rheumatology, Univ Hospital Lund, Lund, Sweden, 20RR 149G, Univ of Manitoba, Winnipeg, MB, Canada, 21Division of Rheumatology, Toronto Western Hospital, Toronto, AB, Canada, 22Biocruces Health Research Institute, Barakaldo, Spain, 23Autoimmune and Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, NY, 24AMC, F4-214, Amsterdam Rheumatology and Immunology Center, Amsterdam, Netherlands, 25University of Glasgow, Glaskow, United Kingdom, 26Rheumatology, Univ. Hospital, Reykjavik, Iceland, 27Lupus Research Unit, Lupus Research Unit, The Rayne Institute, King's College London School of Medicine, St Thomas' Hospital, London, United Kingdom, 28Rheumatology, Division of Rheumatology, Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, 29Rheumatology, Columbia University, New York, NY, 30Division of Rheumatology, Allergy & Immunology, UCSD School of Medicine Center for Innovative Therapy, La Jolla, CA, 31UNC Kidney Centre, Chapel Hill, NC, 32Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, 33Medicine/Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, 34Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark, 35Hospital Clinic, Barcelona, Spain, 36Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey, 37Research Institute of the McGill University Health Centre, Montreal, QC, Canada, 38FSM, Northwestern University, Chicago, IL

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Monday, November 6, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: We assessed incident cancers in a large inception SLE cohort, and examined demographic and clinical factors, including tumor-related autoantibodies against proliferating cell nuclear antigen (PNCA) and centromere protein B (CENP-B).

Methods: Patients with new-onset SLE were enrolled at 32 centres. Incident cancers were recorded by physicians at annual visits, confirmed by chart review. Of 1,848 patients enrolled from 2000-2011, we studied 1,676 who had at least one follow-up visit. Multivariate survival regression was performed, with baseline demographics (age, sex, race), drugs (corticosteroids, anti-malarial drugs, immunosuppressives), smoking, SLEDAI-2K, and calendar year. Serology was available in 29 cancer cases and 1114 cancer-free patients. Subjects were followed until death, last visit, or end of the interval for this analysis (August 2015).

Results: Of the 1,676 patients evaluated, the majority (88.7%) were female, and 828 (49.4%) were Caucasian. Mean age at SLE diagnosis was 34.6 (standard deviation 13.3) years. At baseline, 1085 (64.7%) patients were never-smokers, with the remainder being current (n=248) or ex-smokers (n=342). Mean follow up was 7 years,

We observed 45 cancers in 45 subjects, occurring at a mean SLE duration of 4.6 (SD 3.1) years. Cancers included breast (9), non-melanoma skin (8), lung (5), prostate (5), head and neck (4), hematologic (3) cervical (3), thyroid (2), melanoma (2) and one each of meduloblastoma, renal carcinoma, carcinoid, thymoma, and dermatofibrosarcoma. Baseline anti-PNCA and anti-CENP-B antibodies were respectively found in 80 (7.2%, 95% CI 5.8, 8.9) and 26 (2.2%, 95% CI 1.6,3.4) of cancer-free patients, and none of the 29 cancer cases where serology was tested (including all 5 lung cancers).

Univariate hazard regression suggested that across all cancers, events were more common in whites and older patients; similar trends were evident in the multivariate analyses, but 95% CIs around the adjusted hazard ratio, HR, estimates were relatively wide.

Analyses for all cancers

Univariate

HR (95% CI)

Multivariate

HR (95% CI)

Age at enrolment

1.05 (1.03, 1.07)

1.04 (1.02, 1.07)

White

2.95 (1.52, 5.72)

2.03 (0.99, 4.14)

Disease duration

0.91 (0.39, 2.15)

0.83 (0.34, 2.05)

Current smoker

1.72 (0.85, 3.48)

1.55 (0.75, 3.19)

Ever used steroids

1.06 (0.51, 2.21)

1.66 (0.75, 3.67)

Ever used antimalarials

1.11 (0.59, 2.09)

0.92 (0.48, 1.78)

Ever immunosuppressives

0.84 (0.46, 1.54)

1.00 (0.51, 1.96)

SLEDAI 2K

0.94 (0.88, 1.00)

0.96 (0.89, 1.03)

Calendar year at enrolment

1.05 (0.94, 1.16)

1.05 (0.94, 1.17)

For lung cancer specifically, the adjusted hazard regression showed age and smoking were factors clearly associated with risk (adjusted HR for smoking 31.4, 95% CI 3.0, 327.1).

Conclusion: This was a first look at potentially predictive factors, including baseline levels of two tumor-associated antibodies, for cancer risk in a large inception SLE cohort. At a mean follow up time of 7 years, baseline smoking was more helpful in identifying future cancer events (specifically lung cancer), than baseline anti-tumor antibodies. However, additional work will assess a broader range of tumor-associated antibodies and follow-up over a longer period.

Disclosure: S. Bernatsky, None; M. Urowitz, None; J. G. Hanly, None; A. E. Clarke, None; M. J. Fritzler, Inova Diagnostics, Inc., 5; C. Gordon, None; J. Romero-Diaz, None; G. S. Alarcón, None; S. C. Bae, None; M. Petri, Anthera Inc, 5,GlaxoSmithKline, 5,EMD Serono, 5,Eli Lilly and Company, 5,Bristol Meyer Squibb, 5,Amgen, 5,United Rheumatology, 5,Global Academy, 5,Exagen, 2; J. T. Merrill, Anthera Pharmaceuticals, Lilly, EMD Serono, GlaxoSmithKline and Biogen., 5; D. J. Wallace, None; P. R. Fortin, None; D. D. Gladman, None; D. A. Isenberg, EMD Serono, Inc, 5; A. Rahman, None; S. Manzi, Exagen, 2,Exagen, 7,Exagen, 5; O. Nived, None; G. K. Sturfelt, None; C. A. Peschken, None; J. Sanchez-Guerrero, None; G. Ruiz-Irastorza, None; C. Aranow, None; R. F. van Vollenhoven, AbbVie, Amgen, Biotest, BMS, Celgene, Crescendo, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB, and Vertex, 2,AbbVie, Amgen, Biotest, BMS, Celgene, Crescendo, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB, and Vertex, 5,AbbVie, Amgen, Biotest, BMS, Celgene, Crescendo, GlaxoSmithKline, Janssen, Lilly, Merck, Novartis, Pfizer, Roche, UCB, and Vertex, 9; A. Zoma, None; K. Steinsson, None; M. A. Khamashta, None; E. M. Ginzler, None; A. Askanase, Exagen, 2; K. C. Kalunian, Pfizer Inc, Gilead, UCB, Amgen, 2; M. A. Dooley, None; S. S. Lim, None; D. L. Kamen, None; S. Jacobsen, None; M. Ramos-Casals, None; M. Inanc, None; J. L. Lee, None; R. Ramsey-Goldman, None.

To cite this abstract in AMA style:

Bernatsky S, Urowitz M, Hanly JG, Clarke AE, Fritzler MJ, Gordon C, Romero-Diaz J, Alarcón GS, Bae SC, Petri M, Merrill JT, Wallace DJ, Fortin PR, Gladman DD, Isenberg DA, Rahman A, Manzi S, Nived O, Sturfelt GK, Peschken CA, Sanchez-Guerrero J, Ruiz-Irastorza G, Aranow C, van Vollenhoven RF, Zoma A, Steinsson K, Khamashta MA, Ginzler EM, Askanase A, Kalunian KC, Dooley MA, Lim SS, Kamen DL, Jacobsen S, Ramos-Casals M, Inanc M, Lee JL, Ramsey-Goldman R. Cancer in an SLE Inception Cohort: Smoking May out-Perform Tumor Markers As a Risk Predictor [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/cancer-in-an-sle-inception-cohort-smoking-may-out-perform-tumor-markers-as-a-risk-predictor/. Accessed .

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