Ankylosing spondylitis and the risk of cancer

Chang, Chih Cheng; Chang, Chien-Chi; Nguyễn, Phụng Anh; Chang, Tzu Hao; Shih, Ya-Ling; Chang, Wen Ying; Horng, Jorng-Tzong; Lee, Oscar K.; Ho, Jennifer H.

doi:10.3892/ol.2017.6368

Cited by 33 publications

(22 citation statements)

References 33 publications

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“…In contrast, while the incidence of cancer was much higher in AS patients first diagnosed at 60‐80 years of age, there was no difference between patients with and without AS. Similar findings have been observed previously in the literature 12,13 …”

Section: Discussionsupporting

confidence: 93%

“…A significant increase in the risk of prostate cancer was observed in male AS patients. Increased risk of prostate cancer was also observed in a Taiwanese cohort (standardized incidence ratio [SIR] 1.64, 95% CI: 1.04‐2.47) 12 and a Korean cohort of AS patients (SIR 1.97, 95% CI: 1.59‐2.35) 14 . Given AS disproportionally effects males, the role of androgens has been investigated as a potential contributor to the increased risk of prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

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Cancer diagnosis and mortality in patients with ankylosing spondylitis: A Western Australian retrospective cohort study

et al. 2020

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Aim Ankylosing spondylitis (AS) has been associated with a modest increase in the risk of cancer. However, little is known as to how AS influences risk of mortality following cancer diagnosis. This study compared the risk of cancer and subsequent mortality in patients with AS compared with a non‐AS population group. Methods Patients diagnosed with AS in Western Australia (WA) between 1980 and 2014 were identified from the WA Rheumatic Disease Epidemiological Register (N = 2152; 31 099 patient‐years). A non‐AS comparison group (N = 10 760; 165 609 patient‐years) was selected from hospital records, matched 1:5 on age, Aboriginality, and gender. Data on cancer diagnosis, comorbidities and mortality were extracted from state cancer, hospital, and mortality registers. The relative risk of cancer (overall and by type) and mortality following cancer diagnosis between AS and non‐AS comparators was compared using Cox proportional hazard models, adjusting for risk factors and comorbidities. Results Ankylosing spondylitis patients had a 15% increase in the crude risk of cancer (hazard ratio [HR]: 1.15, 95% CI: 1.02‐1.30). However, this association was attenuated following adjustment for smoking and common comorbidities (adjusted HR: 1.08, 95% CI: 0.95‐1.22). Following a cancer diagnosis, patients with AS had an increased risk of 5‐year mortality in the unadjusted (HR: 1.24, 95% CI: 1.03‐1.49) and the adjusted models (adjusted HR: 1.37, 95% CI: 1.13‐1.66). Conclusion Ankylosing spondylitis was not associated with an increased risk of cancer diagnosis. Following a cancer diagnosis, AS was associated with an increased risk of 5‐year mortality.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Cancer diagnosis and mortality in patients with ankylosing spondylitis: A Western Australian retrospective cohort study

et al. 2020

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“…However, we have no data regarding whether HLA‐B*27:05 is associated with other systemic irAEs caused by atezolizumab or whether HLA‐B*27:05 increases the risk of irAEs induced by other ICPIs, such as CTLA‐4 or PD‐1 inhibitors. In addition, because patients with HLA‐B27 or ankylosing spondylitis have an slightly increased risk of hematologic malignancy or systemic cancer, 39,40 it is also necessary to analyze the prevalence of HLA‐B27 in the control cancer patients. Until then, our data suggest that HLA‐B*27:05 might be a risk factor gene for CNS‐irAEs induced by atezolizumab.…”

Section: Discussionmentioning

confidence: 99%

HLA‐B27 association of autoimmune encephalitis induced by PD‐L1 inhibitor

Chang

Shin

Keam

et al. 2020

Ann Clin Transl Neurol

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Objective: While immune checkpoint inhibitors are increasingly used for various cancers, unpredictable immune-related adverse events (irAEs) such as autoimmune encephalitis is life-threatening. Here, we report an association between human leukocyte antigen (HLA) and atezolizumab-induced encephalitis. Methods: From an institutional prospective cohort for encephalitis, we identified patients with autoimmune encephalitis after the use of atezolizumab, a PD-L1 (programmed death-ligand 1) inhibitor, from August 2016 to September 2019 and analyzed their HLA genotypes. Results: A total of 290 patients received atezolizumab, and seven patients developed autoimmune encephalitis, and five of whom were enrolled for the analysis. The patients presented altered mentality, seizures, or myelitis. Three patients had the HLA-B*27:05 genotype in common (60%), which is significantly frequent given its low frequency in the general population (2.5%). After Bonferroni correction, HLA-B*27:05 was significantly associated with autoimmune encephalitis by atezolizumab (corrected P < 0.001, odds ratio 59, 95% CI = 9.0~386.9). Interpretation: Here we found that three in five patients with autoimmune encephalitis associated with atezolizumab had the rare HLA-B*27:05 genotype. Further systematic analyses in larger cohorts are necessary to investigate the value of HLA screening to prevent the life-threatening adverse events.

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“…Although there is no definite evidence linking AS and thymoma, 2 studies in Taiwan reported that the incidence of tumors in AS patients to be 1.15 times that of patients without AS. [ 9 ] The incidence of gynecologic tumors, head and neck tumors, and bladder cancer in AS patients is 1.97 to 3.22 times that of non-AS patients. The risk of liver cancer and lung cancer is significantly higher in AS patients than in controls.…”

Section: Discussionmentioning

confidence: 99%

Membranous nephropathy and thymoma in a patient with ankylosing spondylitis

et al. 2020

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Rationale: We report a rare case with ankylosing spondylitis (AS), thymoma, and membranous glomerulonephritis. The pathogenic mechanisms of these 3 diseases may be associated with each other. Here, we discuss the course of diagnosis and treatment. Patient concerns: A 64-year-old woman with bilateral pain of the sacroiliac joints for 10 years and anasarca for 10 days. Diagnoses: A diagnosis of AS by HLA-B27 and pelvic X-ray tests, thymoma based on computed tomography and pathological diagnosis, and membranous glomerulonephritis based on renal biopsy. Interventions: We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD, for a month. Outcomes: The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin/creatinine decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved, and the Bath Ankylosing Spondylitis Disease Activity Index score dropped to 4.0. Lessons: Although the causal relationship between AS, thymoma, and membranous nephropathy in this patient still needs to be established, the pathogenesis between the 3 diseases may have some association. In clinical practice, patients with AS need to be screened for tumors and renal complications.

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Ankylosing spondylitis and the risk of cancer

Cited by 33 publications

References 33 publications

Cancer diagnosis and mortality in patients with ankylosing spondylitis: A Western Australian retrospective cohort study

Cancer diagnosis and mortality in patients with ankylosing spondylitis: A Western Australian retrospective cohort study

HLA‐B27 association of autoimmune encephalitis induced by PD‐L1 inhibitor

Membranous nephropathy and thymoma in a patient with ankylosing spondylitis

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