Malignancy in ankylosing spondylitis: a cross-sectional analysis of a large population database

Abstract

Background Increased cancer-risk has been reported with rheumatoid arthritis and systemic lupus erythematosus, but the risk is poorly studied in ankylosing spondylitis (AS). Conflicting data in AS have been reported in Asia and Europe, with lack of US population-based studies. Our objective is to study the prevalence of cancer in patients with AS in the US. Methods Using the Explorys database, we performed a cross-sectional study. Data from AS patients and controls were stratified by 2 rheumatology visits, age groups, clinical characteristics, and frequency of cancers. The data were analyzed using a series of chi-square tests of independence as well as logistic regression to test for association between AS and cancer. Results 1410 AS patients (12.88%) had cancer. Female AS patients had a lower prevalence of cancer compared to controls (OR 0.840, 95% CI [0.769, 0.916]), while male AS patients had no statistically significant difference (OR 1.011, 95% CI [0.929, 1.099]). Among patients with AS, Skin cancers (squamous cell, malignant melanoma, and basal cell) and head and neck cancers were significantly increased. Conclusion Our study demonstrated that the prevalence of “any-type-cancer” was not increased in AS patients compared to controls with no rheumatic disease. Skin, head, and neck cancers were more frequently seen in AS patients.

Time Trend Analysis of Comorbidities in Ankylosing Spondylitis: A Population-Based Study from 53,142 Hospitalizations in Poland

“…Consequently, our findings show associations between a risk of hospitalization and cardiopulmonary comorbidities. Our outcomes stay in line with other research such as the study by Bittnar et al, which was obtained from the US population [16] and other studies [46]. In the analysis of hospitalized patients, we found that 45% of patients were diagnosed during hospitalization for CV condition, but also that 32% of AS patients were hospitalized due to obstructive airways diseases.…”

“…On the contrary, Feltelius et al [15], in their retrospective analysis, reported only increased prevalence of kidney neoplasm, which was not observed by Bittar et al [16]. Research by Bitter stated that among patients with AS, skin cancers (squamous cell, malignant melanoma, and basal cell) and head and neck cancers were reported as significantly increased [16]. Similar observations were made by Kagan et al [17], who reported increased risk for solid tumors in AS.…”

“…In patients from Hong Kong, Chang et al [14] reported an increased risk of hematological malignancy in both sexes, colon cancer in females, and bone and prostate cancer in males. On the contrary, Feltelius et al [15], in their retrospective analysis, reported only increased prevalence of kidney neoplasm, which was not observed by Bittar et al [16]. Research by Bitter stated that among patients with AS, skin cancers (squamous cell, malignant melanoma, and basal cell) and head and neck cancers were reported as significantly increased [16].…”

“…Constant inflammatory state and gene changes that lead to ankylosing spondylitis could also play a role in cancer development. The results from national registers [14][15][16][17] revealed that the overall incidence of cancer seems to be elevated in patients with AS, yet the outcomes between populations seem to differ. In patients from Hong Kong, Chang et al [14] reported an increased risk of hematological malignancy in both sexes, colon cancer in females, and bone and prostate cancer in males.…”

Is low‐dose tumor necrosis factor inhibitor effective and safe in patients with ankylosing spondylitis flare‐up after renal transplantation? A case report and literature review

“…Rheumatic diseases themselves, the immunosuppressant drugs used after receiving solid organ transplantation to prevent graft rejection, and the biologics used for controlling rheumatic diseases, especially TNFi, could all increase the risk of malignancy. A cross-section analysis of malignancy in AS patients using a large US healthcare database revealed that AS patients do not have an increased prevalence of "any-type-cancer" compared with control patients without a rheumatic disease, 6 but studies from Asia revealed an increased risk of cancer in AS patients, especially in Taiwan. [7][8][9][10] Another systematic review also showed a 14% increase in the overall risk for malignancy, with patients from Asia at the highest risk based on a subgroup analysis.…”