Systemic Sclerosis and Lung Cancer Risk: Data from the Canadian Scleroderma Research Group

Lama Sakr¹, Elie Younanian², Marie Hudson³, Mianbo Wang⁴, Murray Baron⁵ and Sasha Bernatsky⁶, ¹Division of Pulmonary Diseases, Jewish General Hospital, Montreal, QC, Canada, ²Division of Pulmonary Diseases, McGill University, Montreal, QC, Canada, ³McGill University, Jewish General Hospital, Montreal, QC, Canada, ⁴Lady Davis Institute for Medical Research, Montreal, QC, Canada, ⁵Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, QC, Canada, ⁶Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: cancer and scleroderma, Lung Disease

Session Information

Date: Monday, November 9, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:

The literature supports an increased incidence of certain malignancies in patients with systemic sclerosis (SSc), including lung cancers. Predictors of lung cancer in SSc remain uncertain. We aim to identify potential independent predictors of lung cancer risk in SSc.

Methods:

Our analyses were based on data from the Canadian Scleroderma Research Group (CSRG) registry, an open cohort of 1560 patients with SSc, who were enrolled from 2004 and followed for a maximum of 11 years. Lung cancer cases occuring at any time after the baseline CSRG visit were identified based on physician reports at each annual follow-up visit. Time to lung cancer diagnosis was calculated from the onset of the first non-Raynaud symptoms, with left censoring to account for time between onset of first non-Raynauds symptoms and cohort entry. Demographic, clinical and serological characteristics of patients with and without lung cancer were compared. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs), with the outcome of lung cancer adjusted for sex, age, race/ethnicity and the number of pack-years smoked.

Results:

Over the 5487.32 total person-years of follow-up, a total of 18 SSc patients were diagnosed with lung cancer (0.33 cancers per 100 person-years). Nine patients (9/27) were excluded from the cox analysis because of diagnosis of cancer prior to cohort entry. Patients with lung cancer were older at cohort entry (60.6 ± 11.4 standard deviation, SD vs. 55.5 ± 12.3 SD years), and more likely to have a past or current smoking history (88.9 vs. 59.1%), a higher prevalence of interstitial lung disease (65.4% vs. 30.2%), lower FVC (87% vs. 91.6% predicted) and more severe gas exchange abnormalities (DLCO 52.3% vs. 72.7% predicted). Male sex (HR, 3.13; 95% CI, 1.06-9.09), the presence of intersitital lung disease at cohort entry (HR, 2.96; 95% CI, 1.10-7.96) and smoking (HR, 6.17; 95% CI, 1.29- 29.50) were independently associated with an increased risk of lung cancer, after adjusting for age and race/ethnicity.

Conclusion:

Smoking history is an important predictor of lung cancer in SSc. Male sex and ILD are also associated with an increased risk of lung cancer in SSc, independent of smoking history.

Disclosure: L. Sakr, None; E. Younanian, None; M. Hudson, None; M. Wang, None; M. Baron, None; S. Bernatsky, None.

To cite this abstract in AMA style:

Sakr L, Younanian E, Hudson M, Wang M, Baron M, Bernatsky S. Systemic Sclerosis and Lung Cancer Risk: Data from the Canadian Scleroderma Research Group [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/systemic-sclerosis-and-lung-cancer-risk-data-from-the-canadian-scleroderma-research-group/. Accessed .

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