Cancer risk in Korean patients with Behçet’s disease: A nationwide population-based study

Abstract

BackgroundVarious immune-mediated diseases are associated with increased malignancy risks. However, the relationship between Behçet’s disease (BD) and cancer remains unclear. We conducted a nationwide, population-based study to determine the risk of cancer in patients with BD.MethodsUsing National Health Insurance claims records, we collected data from 2402 patients diagnosed with BD between 2013 and 2014. Standardized incidence ratios (SIRs) of overall and site-specific cancers in patients with BD in comparison with the general population were calculated.ResultsThe risks of overall cancer (SIR, 3.54; 95% confidence interval, 2.35–5.11 in men and 2.17; 1.58–2.92 in women) and solid cancer (3.10; 1.94–4.69 in men and 2.13; 1.52–2.90 in women) were greater in patients with BD than in the general population. There were significantly increased risks for these solid cancers: colorectal (4.26; 1.38–9.94), liver (4.00; 1.09–10.25), bone/articular cartilage (55.66; 1.41–310.14), prostate (7.05; 1.45–20.60), and brain/central nervous system (28.32; 3.43–102.31) in men; and the lips/oral cavity/pharynx (13.97, 1.69–50.47), liver (12.78; 5.14–26.33), lungs (4.35; 1.18–11.13), other female genital organs (53.57; 1.36–298.49), and eyes (128.26; 3.24–714.59) in women. Patients with BD had a greater risk of myelodysplastic syndrome (MDS) than the general population did (65.72; 7.96–237.41 in men and 53.86; 11.11–157.40 in women), but not of hematological cancer.ConclusionsCompared to the general population, Korean patients with BD had greater risks of overall cancer, some solid cancers, and MDS, but not of hematological cancer.

Hepatocellular carcinoma associated to Behçet's disease

“…The risk of elevated hepatic carcinogenesis associated with BD was confirmed by the Korean national study of Jung YS et al, where SIR to develop hepatic cancer during this disease was equal to 4.00 compared to the general population [9] .…”

“…Indeed, the risk of any cancer during BD was significantly higher in the multiple nationalwide populationbased studies compared to the general population: standardized incidence ratio (SIR) was 3.10 in men and 2.13 in women with BD in Jung YS et al series [9] , SIR was 1.5 in all patients and 1.8 in female patients with BD in Wang LH et al study [19] , and Hazard Ratio (HR) was 1.134 in Na SJ et al series [10] .…”

“…However, liver cancer remains exceptional in BD: 2 patients out of 512 with BD in the Turkish series of Bayraktar Y et al (0.39%) [20] and 22 patients among 14,137 in the Korean series of Na SJ et al (0.20%) [10] . The majority of cases were hepatocellular carcinoma [9][10][11][12] , more rarely other types of liver cancer were reported: malignant hepatoma [12] and liver leiomyosarcoma [13] .…”

“…Behçet's disease (BD) is a non-specific systemic vasculitis that is particularly common in young people around the Mediterranean and the old Silk Road [6] . Recently a particularly increased risk of cancer during this disease was reported by several studies [6][7][8] : standardized incidence ratio (SIR) at 2.13-3.10 [9] and Hazard Ratio (HR) at 1.134 [10] .…”

“…Only a few sporadic cases of liver cancer associated with BD have been reported [9][10][11][12][13] , and in large series like the South Korean series of 14,137 patients with BD, the frequency of HCC did not exceed 0.20% [10] .…”