Cancer in Systemic Lupus Erythematosus: Results from the Systemic Lupus International Collaborating Clinics Inception Cohort

Sasha Bernatsky¹, Murray Urowitz², John Hanly³, Ann E. Clarke⁴, Caroline Gordon⁵, Juanita Romero-Diaz⁶, Graciela S. Alarcon⁷, Sang-Cheol Bae⁸, Michelle Petri⁹, Joan T. Merrill¹⁰, Daniel J Wallace¹¹, Paul R. Fortin¹², Dafna D. Gladman¹³, David A. Isenberg¹⁴, Anisur Rahman¹⁵, Susan Manzi¹⁶, Ola Nived¹⁷, Gunnar K. Sturfelt¹⁸, Christine Peschken¹⁹, Jorge Sánchez-Guerrero²⁰, Guillermo Ruiz-Irastorza²¹, Cynthia Aranow²², Ronald F. van Vollenhoven²³, Asad Zoma²⁴, Kristján Steinsson²⁵, M Khamashta²⁶, Ellen M. Ginzler²⁷, Anca Askanase²⁸, Kenneth C. Kalunian²⁹, Mary Anne Dooley³⁰, S. Sam Lim³¹, Diane L. Kamen³², Søren Jacobsen³³, Manuel Ramos-Casals³⁴, Murat Inanc³⁵, Jeremy Labrecque³⁶, Jennifer LF Lee³⁷ and Rosalind Ramsey-Goldman³⁸, ¹Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada, ²Medicine, Toronto Western Hospital and University of Toronto, 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, ⁵NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom, ⁶Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico, ⁷Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, ⁸Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, Republic of, ⁹Rheumatology Division, Johns Hopkins University School of Medicine, Baltimore, MD, ¹⁰Oklahoma Medical Research Foundation, Oklahoma City, OK, ¹¹Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, ¹²Université Laval, CHU de Québec, Québec, QC, Canada, ¹³Rheumatology, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, ¹⁴Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom, ¹⁵Rayne Institute, Centre for Rheumatology Research, UCL Division of Medicine, London, United Kingdom, ¹⁶Lupus Center of Excellence, West Penn Allegheny Health System, Pittsburgh, PA, ¹⁷Department of Rheumatology, University Hospital, Lund, Sweden, ¹⁸Department of Rheumatology, Univ Hospital Lund, Lund, Sweden, ¹⁹Medicine & Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, ²⁰Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, Mexico, ²¹Universidad del Pais Vasco, Servicio de Medicina Interna, Hospital de Cruces, Bizkaia, Spain, ²²Feinstein Institute for Medical Research, Manhasset, NY, ²³Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, Netherlands, ²⁴Hairmyres Hospital, Scotland, United Kingdom, ²⁵Rheumatology, Univ. Hospital, Reykjavik, Iceland, ²⁶Lupus Research Unit, Lupus Research Unit, The Rayne Institute, King's College London School of Medicine, St Thomas' Hospital, London, United Kingdom, ²⁷Rheumatology, SUNY Downstate Medical Center, Brooklyn, NY, ²⁸NYU, Seligman Centre for Advanced Therapeutics, New York, NY, ²⁹Division of Rheumatology, Allergy & Immunology, UCSD School of Medicine Center for Innovative Therapy, La Jolla, CA, ³⁰Dooley Rheumatology, Chapel Hill Doctors, Chapel Hill, NC, ³¹Medicine, Emory University School of Medicine, Atlanta, GA, ³²Medicine/Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, ³³Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, ³⁴Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, ³⁵Internal Medicine, Istanbul University, Istanbul, Turkey, ³⁶Clinical Epidemiology, McGill UHC/RVH, Montreal, QC, Canada, ³⁷Clinical Epidemiology Rheum, McGill UHC/RVH, Montreal, QC, Canada, ³⁸FSM, Northwestern University, Chicago, IL

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Cancer, Malignancy and systemic lupus erythematosus (SLE)

Session Information

Date: Tuesday, November 15, 2016

Title: 2016 Rheumatology Research Foundation Edmond L. Dubois, MD Memorial Lectureship

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose: Published studies of cancer risk in SLE to date have never focussed solely on clinically confirmed, incident patients. Prior studies thus may not reflect the cancer experience of all SLE patients. To fill this knowledge gap, our purpose was to describe cancer incidence in a large inception SLE cohort.

Methods: Patients meeting ACR criteria for new-onset SLE were enrolled across 32 centres. At enrolment and annual assessments, new cancer diagnoses were recorded by the examining physician. Cancers were confirmed by reviewing medical files including pathology reports. Of 1848 patients enrolled across 1999-2011, 1676 had at least one follow-up. Patients were followed until death, last visit, or end of study interval for this analysis(August 2015). Comparison general population cancer rates, weighted according to the age and sex structure of the SLE cohort, were obtained from participating countries.

Results: Mean age at SLE diagnosis was 34.6(standard deviation, SD 13.3). Mean follow-up was 6.85(SD 3.6), for a total of 11,481 patient-years. We observed 46 invasive cancers in 46 subjects. At cancer diagnosis, mean age was 51.6(SD 15.0) and average SLE duration was 4.8(SD 3.1) years. The most common cancer type was breast (n=10), followed by non-melanoma skin cancer (n=8), lung(n=6), prostate(n=5), 4 head and neck (tonsillar, tongue, and 2 oral), cervical(n=2), thyroid(n=2), melanoma(n=2) and one each of non-Hodgkin lymphoma, leukemia, multiple myeloma, , renal carcinoma, gastric carcinoid, thymoma, and dermatofibrosarcoma. Twenty of the 46 patients (43.5%) who developed cancers were current (n=4) or ex-smokers (n=16); five of the six lung cancers were current or ex-smokers. The over-all cancer rate in the SLE population was 4 events per 1000 patient-years(95% CI, 2.9 to 5.4) versus the general population rate of 2.7 events per 1,000 person-years. In young SLE patients(<40), the cancer rate was 2.2 events per 1,000 patient-years(95% CI 1.2, 3.7) which was more than twice that of the general population of this age (1 event per 1,000). The cancer rate in SLE after age 40 was 5 events per 1,000 patient-years, similar to the general population cancer rate for this age group. With very few hematological cancers observed in this inception cohort, the hematological cancer incidence in SLE was 2.6 cancers per 10,000 patient-years (95% CI 0.5, 7.6), which was a non-significant increase above the population rate of 2 per 1,000 person-years. Among other cancer types, only lung cancer was clearly increased versus the general population; the SLE incidence was 5.2 cases per 10,000 person years (95% CI 2-11), versus 1.7 cases per 10,000 person-years in the general population.

Conclusion: The cancer incidence rate in the cohort was 4 events per 1,000. Though higher than general population rates, it is still less than one-half percent per year. Comparisons of cancer in SLE versus the general population must be interpreted with caution, given differences in outcome ascertainment in the two populations. In our analyses, lung cancer was one of the most common cancers. The vast majority of these were smokers, supporting the belief that lung cancer risk in SLE (as in the general population) is largely driven by smoking.

Disclosure: S. Bernatsky, None; M. Urowitz, None; J. Hanly, None; A. E. Clarke, None; C. Gordon, None; J. Romero-Diaz, None; G. S. Alarcon, None; S. C. Bae, None; M. Petri, None; J. T. Merrill, None; D. J. Wallace, None; P. R. Fortin, None; D. D. Gladman, None; D. A. Isenberg, None; A. Rahman, None; S. Manzi, None; O. Nived, None; G. K. Sturfelt, None; C. Peschken, None; J. Sánchez-Guerrero, None; G. Ruiz-Irastorza, None; C. Aranow, None; R. F. van Vollenhoven, None; A. Zoma, None; K. Steinsson, None; M. Khamashta, None; E. M. Ginzler, None; A. Askanase, None; K. C. Kalunian, None; M. A. Dooley, None; S. S. Lim, None; D. L. Kamen, None; S. Jacobsen, None; M. Ramos-Casals, None; M. Inanc, None; J. Labrecque, None; J. L. Lee, None; R. Ramsey-Goldman, None.

To cite this abstract in AMA style:

Bernatsky S, Urowitz M, Hanly J, Clarke AE, Gordon C, Romero-Diaz J, Alarcon GS, Bae SC, Petri M, Merrill JT, Wallace DJ, Fortin PR, Gladman DD, Isenberg DA, Rahman A, Manzi S, Nived O, Sturfelt GK, Peschken C, Sánchez-Guerrero J, Ruiz-Irastorza G, Aranow C, van Vollenhoven RF, Zoma A, Steinsson K, Khamashta M, Ginzler EM, Askanase A, Kalunian KC, Dooley MA, Lim SS, Kamen DL, Jacobsen S, Ramos-Casals M, Inanc M, Labrecque J, Lee JL, Ramsey-Goldman R. Cancer in Systemic Lupus Erythematosus: Results from the Systemic Lupus International Collaborating Clinics Inception Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/cancer-in-systemic-lupus-erythematosus-results-from-the-systemic-lupus-international-collaborating-clinics-inception-cohort/. Accessed .

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