Background The relationship between IgG4-related disease (IgG4-RD) and the risk of malignancy is still controversial. This article focused on assessing the risk of cancer in patients with IgG4-RD by meta-analysis. Methods We conducted a systematic review of the literature and meta-analysis characterizing the associated risk of overall malignancy and four site-specific malignancies (pancreas, lung, gastric and lymphoma) in patients with IgG4-RD. A search from 2003 to 2020 was performed using specified terms from PubMed, Embase, Web of Science and SinoMed. Random-effects model analysis was used to pool standardized incidence ratios (SIRs) and 95% confidence intervals (CIs). Subgroup and sensitivity analyses were conducted to clarify the heterogeneity of the included studies. Begg’s funnel plot and Egger’s linear regression test were used to evaluate the bias of the meta-analysis. A P value < 0.05 indicated the existence of publication bias. Results A total of 10 studies were included in the article. The overall SIR estimates suggested an increased risk of overall cancer in IgG4-RD patients (SIR 2.57 95% CI 1.72–3.84) compared with the general population. The specific SIRs for pancreas and lymphoma were higher than those of the general population in IgG4-RD patients (SIR 4.07 95% CI 1.04–15.92, SIR 69.17 95% CI 3.91–1223.04, respectively). No significant associations were revealed in respiratory and gastric cancer (SIR 2.14 95% CI 0.97–4.75, SIR 0.95 95% CI 0.24–3.95, respectively). Four studies were found to be the major sources of heterogeneity by sensitivity analysis. There was no evidence of publication bias via Egger’s test. Conclusion Compared with the general population, patients with IgG4-RD appear to have a higher risk of overall cancer, especially pancreatic and lymphoma. The risk of lung and gastric cancer was not different between IgG4-RD patients and the general population.
Background Immunoglobulin G4-related lung disease (IgG4-RLD) is a rare entity. We retrospectively analyzed the clinical and histopathological characteristics of patients with pathologically confirmed IgG4-RLD to improve the diagnosis rate and reduce the risk of misdiagnosis. Methods We screened the pathological reports of 4838 patients with pulmonary surgery and/or biopsy specimens from April 2017 to April 2021 at Sun Yat-Sen Memorial Hospital affiliated with Sun Yat-Sen University, and specimens from 65 patients with suspected IgG4-RLD were subjected to immunohistochemical staining for IgG4 and IgG. Finally, 10 patients with definite IgG4-RLD that was pathologically confirmed were enrolled and analyzed. Results The incidence of pathologically confirmed IgG4-RLD was 0.2% (10/4838). The ten patients had an average age of 59.7 years at diagnosis, and the male-to-female ratio was 9:1. The initial clinical manifestations were nonspecific, and cough was the most common symptom (4/10). More than one organ was involved in most patients (8/10), and mediastinal/hilar lymph node involvement was often observed (7/10). Serum IgG4 was analyzed in 6 patients and found to be elevated. Serum tumor marker levels were within the normal range or were slightly elevated. Computed tomography (CT) of the chest and/or 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) imaging revealed that 5 patients had a mixed type, 3 patients had the solid nodular type, and 2 patients had the bronchovascular type. All pulmonary masses and large nodules with solid patterns had spiculated margins and inhomogeneous enhancement with or without pleural indentation and a lobulated appearance. Abundant lymphoplasmacytic cell infiltration and fibrosis were observed in all patients. The expression of IgG4 and IgG was upregulated in the pulmonary sections. Seven patients were treated with glucocorticoids with or without additional immunosuppressants and responded well. Conclusions The results of our study suggest that multiple imaging findings, an elevated serum IgG4 concentration, and no significant increase in serum tumor biomarkers could provide diagnostic support for IgG4-RLD, especially for isolated IgG4-RLD or IgG4-RLD that includes other organ involvement that does not aid in establishing the diagnosis.
Background:This research aimed to explore the utility of and IL-23 as potential biomarkers for the diagnosis and prognosis of sepsis. Material/Methods:This study included 74 adult individuals with sepsis, 45 ICU controls, and 50 healthy individuals attending routine physical examinations. IL-1b and IL-23 levels were assessed and analyzed on the admission day. Univariate Cox regression analyses were utilized to explore the association of IL-1b and IL-23 with sepsis survival. Furthermore, receiver operating characteristic (ROC) analysis was employed to evaluate the value of IL-1b and IL-23 to predict 28-day mortality due to sepsis. Results:Serum concentrations of IL-1b and IL-23 were significantly higher in septic patients relative to healthy and ICU controls (P<0.001). IL-1b and IL-23 levels in non-survivors were significantly higher than in survivors (P<0.001). IL-1b (hazard ratio; HR=1.06, P<0.001) and IL-23 (HR=1.02, P=0.031) were independent risk variables for 28-day mortality in sepsis patients, which were strongly associated with the severity of sepsis. The area under the ROC curve for predicting 28-day fatality in sepsis was 0.66 for IL-1b (P=0.024, 95% confidence interval; CI: 0.54-0.76) and 0.77 for IL-23 (P<0.001, 95% CI: 0.65-0.86). Furthermore, compared with low serum IL-1b (<9.41 pg/mL) and IL-23 (<6.77 pg/mL) levels, septic patients with high serum IL-1b (³9.41 pg/mL) and IL-23 (³6.77 pg/mL) levels had poorer survival. Conclusions:Serum IL-1b and IL-23 values were higher in patients with sepsis and are potential diagnostic and prognostic markers for sepsis, but this needs to be confirmed by prospective studies.
Background: Immunoglobulin G4-related lung disease (IgG4-RLD) is a rare entity. The aim of this study is to retrospectively analyzed the clinicopathological characteristics of IgG4-RLD pathologically confirmed in order to improve the diagnosis and treatment of the disease.Methods: We screened the pathological reports of 4838 patients with pulmonary surgery and/or biopsy specimens at Sun Yat-sen Memorial Hospital affiliated to Sun Yat-sen University from April 2017 to April 2021, and 65 patients with suspected IgG4-RLD had an immunohistochemical staining for IgG4 and IgG. Finally, 10 patients with definite IgG4-RLD pathologically comfirmed were enrolled and analyzed.Results: The incidence of IgG4-RLD pathologically confirmed was 0.2% (10/4838). Ten patients had a mean age of 59.7 years at diagnosis with a male: female ratio of 9:1. The initial clinical manifestations were lack of specificity and cough was the most common symptom (4/10). More than one organ was involved in most patients (8/10) and lymph node involvement was often seen (7/10). Serum IgG4 were detected and elevated in 6 patients. The levels of serum tumor markers were within normal range or slightly elevated. The chest computed tomography (CT) and/or 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) findings showed 5 patients of mix type, 3 patients of solid nodular type and 2 patients of bronchovascular type. All pulmonary mass and large nodules with solid pattern had spiculated margins and inhomogeneous enhancement with or without pleural indentation and lobulated appearance. Abundant lymphoplasmacytic infiltration and fibrosis were observed in all patients. The expressions of IgG4 and IgG in the plasma cells were up-regulated in the immunostained sections of lung. Seven patients received prednisone with or without additional immunosuppressive drugs and responded well.Conclusions: Our study suggests that multiple imaging findings combined with elevated serum IgG4 as well as serum tumor markers without significant increase could provide diagnostic support for IgG4-RLD.
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