Associations between bullous pemphigoid and primary malignant cancers: an English national record linkage study, 1999–2011

Ong, Eugene Liat Hui; Goldacre, Raphael; Hoang, Uy; Sinclair, Rodney; Goldacre, Michael J

doi:10.1007/s00403-013-1399-5

Cited by 52 publications

(51 citation statements)

References 20 publications

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“…While studies initially reported an association between BP and cancer, 1 subsequent studies 4,5 have refuted this association, including a recent British study. 6 Although there is a possibility of increased risk of malignant neoplasm in younger patients with BP, 7 we did not find this association.…”

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confidence: 82%

Association of Bullous Pemphigoid and Malignant Neoplasms

Cai

Allen

et al. 2015

JAMA Dermatol

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Bullous pemphigoid (BP) is the most common autoimmunemediated subepidermal blistering skin disease and occurs mostly in elderly persons. The association of malignant neoplasms with BP has been controversial. 1 This study compared the incidence of cancer in patients with BP with that of the ageand sex-matched general population. with BP were matched with persons in the Singapore Cancer Registry and Death Registry to identify those who had cancer and/or had died. Person-years were accrued from BP diagnosis until death, cancer diagnosis, or December 31, 2011, whichever was earliest. The expected number of cancer cases was calculated as the exposure multiplied by the incidence within each age-and sex-specific category and then summed across all categories for the period 2004-2008 in Singapore. The standardized incidence ratio was calculated as the ratio of observed to expected cancers, and 95% CIs were calculated for the standard incidence ratio based on Poisson distribution. The study was approved by the ethics committee of the National Healthcare Group, Singapore. Patient consent was waived.Results | A total of 359 patients with BP (mean age, 75.7 years; range, 27.8-100.8 years) were included ( Table 1). Of these, 48 (13.4%) had a malignant neoplasm, of which 16 preceded BP diagnosis by more than 5 years (mean, 17.1 years; range, 6.8-26.9 years). Of the 32 recent cancers, 14 occurred within 5 years preceding BP diagnosis. The remaining 18 occurred either in the same year as a BP diagnosis (n = 4) or after BP diagnosis (n = 14). These included 6 lung cancers, 5 skin cancers (nonmelanoma), 3 colorectal cancers, 2 breast cancers, 1 pancreatic cancer, and 1 prostate cancer. The mean follow-up period from BP diagnosis was 2.5 years (range, 0.2-7.4 years); the mean time from BP diagnosis to cancer diagnosis was 0.9 years (range, -1.0 to -4.2 years). The mean time from cancer diagnosis to death was 1.3 years (range, 0-7.4 years), and 7 of the 15 deaths (46.7%) that occurred during follow-up were cancer related.The expected number of incident cancer diagnoses after BP diagnosis was 14.48, with 14 cancers observed (within 4.2 years) after BP diagnosis, yielding an age-and sex-matched standard incidence ratio of 0.97 (95% CI, 0.53-1.62) ( Table 2). There was no association with malignant neoplasms, even when cancers in the concurrent year but preceding BP diagnosis or up to 5 years preceding BP diagnosis were included. No association was observed with any particular type of malignant neoplasm. While studies initially reported an association between BP and cancer, 1 subsequent studies 4,5 have refuted this association, including a recent British study. 6Although there is a possibility of increased risk of malignant neoplasm in younger patients with BP, 7 we did not find this association.Discussion | Our study found no significant increase in the incidence of cancer among patients with BP compared with those in the age-and sex-matched general population. Strengths of this study included a relatively large, welldefined cohort, ...

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confidence: 82%

Association of Bullous Pemphigoid and Malignant Neoplasms

Cai

Allen

et al. 2015

JAMA Dermatol

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“…Since irradiated skin is reported to have increased vascular permeability [35], these autoantibodies may produce BP initially localized to the site of radiation. Additionally, studies have conclusively demonstrated that the correlation between BP and cancer is simply coincidental and not necessarily causative [46,47]. However, in these patients, the cancers were limited to the breast and BP occurred in the majority of cases at the sites of radiation.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Radiation Therapy and Bullous Pemphigoid

2014

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Background: Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease. Objective: To review the literature on radiation therapy (RT)-associated BP. Methods: A review of the English language literature on patients who developed BP during and up to 10 years post RT was performed. Results: 29 patients were reported. 25 (86.2%) were women, 84% of whom had received RT for breast cancer. Three patients were male (10.3%). Gender was not mentioned in 1 (3.4%). 72% developed BP post RT; 28% developed BP while undergoing RT. BP was initially localized to irradiated sites in 25 patients and to non-irradiated sites in 2 patients. Two patients presented with generalized disease. Disease control was reported in 12 patients, partial remission in 7 and complete remission in 5. Conclusion: The clinical profile, response to therapy and clinical outcome may indicate that RT-associated BP may be a specific subset of BP with a relatively benign course.

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“…In a trial of a somatostatin analog, ocreotide, the rate of kidney volume increase was slowed compared with placebo, 32 and post hoc analyses suggested that octreotide may also reduce liver parenchyme and cyst expansion. 33 However, it also led to increased numbers of nonserious reports of gallstones (octreotide: ten of 40 3%]). The two reported serious cases of acute cholecystitis in this study were both among those allocated octreotide.…”

Section: Discussionmentioning

confidence: 99%

“…We used anonymized linked all England HES inpatient records with additional linkage to national mortality records. 40 Since 1998, HES have recorded information on all hospital inpatient activity in England, including dates of admission and discharge; demographics (including age, sex, and ethnicity); measures of social deprivation; the primary diagnostic reason for admission with relevant secondary diagnoses coded using the International Statistical Classification of Diseases and Related Health Problems Revision 10 (ICD-10) 41 ; and all procedures coded using the Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures (OPCS), version 4.…”

Section: Disease Association Study Using All England Hospital Episodementioning

confidence: 99%

Biliary Tract and Liver Complications in Polycystic Kidney Disease

Judge

Harper

Storey

et al. 2017

JASN

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Polycystic liver disease is a well described manifestation of autosomal dominant polycystic kidney disease (ADPKD). Biliary tract complications are less well recognized. We report a 50-year single-center experience of 1007 patients, which raised a hypothesis that ADPKD is associated with biliary tract disease. We tested this hypothesis using all England Hospital Episode Statistics data (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012), within which we identified 23,454 people with ADPKD and 6,412,754 hospital controls. Hospitalization rates for biliary tract disease, serious liver complications, and a range of other known ADPKD manifestations were adjusted for potential confounders. Compared with non-ADPKD hospital controls, those with ADPKD had higher rates of admission for biliary tract disease (rate ratio [RR], 2.24; 95% confidence interval [95% CI], 2.16 to 2.33) and serious liver complications (RR, 4.67; 95% CI, 4.35 to 5.02). In analyses restricted to those on maintenance dialysis or with a kidney transplant, RRs attenuated substantially, but ADPKD remained associated with biliary tract disease (RR, 1.19; 95% CI, 1.08 to 1.31) and perhaps with serious liver complications (RR, 1.15; 95% CI, 0.98 to 1.33). The ADPKD versus non-ADPKD RRs for biliary tract disease were larger for men than women (heterogeneity P,0.001), but RRs for serious liver complications appeared higher in women (heterogeneity P,0.001). Absolute excess risk of biliary tract disease associated with ADPKD was larger than that for serious liver disease, cerebral aneurysms, and inguinal hernias but less than that for urinary tract infections. Overall, biliary tract disease seems to be a distinct and important extrarenal complication of ADPKD.

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Associations between bullous pemphigoid and primary malignant cancers: an English national record linkage study, 1999–2011

Cited by 52 publications

References 20 publications

Association of Bullous Pemphigoid and Malignant Neoplasms

Association of Bullous Pemphigoid and Malignant Neoplasms

Relationship between Radiation Therapy and Bullous Pemphigoid

Biliary Tract and Liver Complications in Polycystic Kidney Disease

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