Hormonal Dependence and Cancer in Systemic Lupus Erythematosus

• Published in: Arthritis care & research (2010) Vol. 72; no. 2; pp. 216 - 224
• Main Authors: Cobo‐Ibáñez, Tatiana, Urruticoechea‐Arana, Ana, Rúa‐Figueroa, Iñigo, Martín‐Martínez, María A., Ovalles‐Bonilla, Juan Gabriel, Galindo, María, Calvo‐Alén, Jaime, Olivé, Alejandro, Fernández‐Nebro, Antonio, Menor‐Almagro, Raúl, Tomero, Eva, Horcada, Loreto, Uriarte‐Itzazelaia, Esther, Martínez‐Taboada, Víctor M., Andreu, José Luis, Boteanu, Alina, Narváez, Javier, Bohorquez, Cristina, Montilla, Carlos, Santos, Gregorio, Hernández‐Cruz, Blanca, Vela, Paloma, Salgado, Eva, Freire, Mercedes, Hernández‐Beriain, José Ángel, Díez‐Álvarez, Elvira, Expósito, Lorena, Fernández‐Berrizbeitia, Olaia, Velloso‐Feijoo, María Luisa, Ibáñez‐Barceló, Mónica, Lozano‐Rivas, Nuria, Bonilla, Gema, Moreno, Mireia, Raya, Enrique, Quevedo‐Vila, Víctor Eliseo, Vázquez‐Rodríguez, Tomas Ramón, Ibáñez‐Ruan, Jesús, Muñoz‐Fernández, Santiago, Sánchez‐Alonso, Fernando, Pego‐Reigosa, José María
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2020
• Subjects: Adult; Aged; Angiotensin-converting enzyme inhibitors; Breast; Cancer; Cohort Studies; Endometrium; Female; Health risk assessment; Hormones - blood; Humans; Longitudinal Studies; Lupus; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - diagnosis; Lupus Erythematosus, Systemic - epidemiology; Male; Middle Aged; Neoplasms - blood; Neoplasms - diagnosis; Neoplasms - epidemiology; Prostate; Regression analysis; Retrospective Studies; Rheumatology; Spain - epidemiology; Systemic lupus erythematosus; Young Adult; Spain
• ISSN: 2151-464X; 2151-4658
• DOI: 10.1002/acr.24068

Objective To estimate the incidence and analyze any cancer‐associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone‐sensitive (HS) and non‐HS cancers. Methods This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post‐SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non‐HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built. Results A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15–1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84–2.91]). The SIR in women with HS versus non‐HS cancer was 1.02 (95% CI 0.13–1.91) and 1.93 (95% CI 0.98–2.89). In HS versus non‐HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin‐converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non‐HS cancers. Conclusion Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non‐HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed.