Risk of cancer in patients with Guillain-Barr� syndrome (GBS)

Abstract

The possible relationship between Guillain-Barré syndrome (GBS) and cancer is still controversial and the existence of a paraneoplastic GBS remains unconfirmed. To better define whether there is a relationship between GBS and malignancy, we compared the observed and the expected number of patients with tumours in a population-based cohort of subjects with GBS. Clinical differences between GBS patients with or without malignancies were analysed. Data were obtained from the Piemonte and Valle d'Aosta Register for GBS (PARGBS) (years 1990-1998). GBS was diagnosed according to NINCDS criteria. The number of expected cases of malignancy in the PARGBS population was calculated using the incidence rate of all types of cancer (ICD codes 140-208) in Piemonte [1985-1987], and in the most important town of this region, that is Turin (years 1993-1997). In the nine-year period, 435 incident patients with GBS were found. Nine of them developed cancer in the six months preceding or following GBS; in seven of them, the diagnosis of cancer and GBS was concomitant. The expected number of malignant tumours was 3.7 (using the incidence in Piemonte) and 3.8 (using the incidence in Turin); therefore, the odds ratios were 2.43 (95 % CI, 1.11-4.62) and 2.37 (95% CI, 1.09-4.50), respectively (p<0.01). Although the cases with malignancies were clinically similar to the other cases of GBS observed through the Register, the mortality in GBS patients with cancer was higher and was the final cause of death in two patients affected by severe cancer. These results suggest a possible correlation between some cases of GBS and cancer. However, GBS in cancer patients does not meet all the criteria for paraneoplastic diseases.

Immune-mediated Neuropathy with Anti-disialosyl IgM Antibodies in Diffuse Large B-cell Lymphoma: A Case Report and Literature Review

“…Some reports have supported the possible correlation between GBS and cancer (14,15), and it is hypothesized that the pathophysiology is due to antibodies derived from the molecular mimicry of antigens in lymphoma cells which may attack similar antigens in the peripheral nerve cells (1). Among the patients which were listed in Table, Noguchi et al demonstrated that their patient's B cell lymphoma produced a monoclonal IgM autoantibody against glycolipids GM1 and GD1b, which caused multifocal motor neuropathy (5).…”

Update on Paraneoplastic Neurologic Disorders

“…Ig. There is some evidence suggesting that patients with GBS and cancer have a worse neurologic outcome than those without cancer [95].…”

Paraneoplastic Neurological Disorders in Leukemia and Lymphoma

“…Patients with Hodgkin lymphoma are at increased risk of developing an acute polyradiculoneuritis identical to Guillain-Barré syndrome (GBS) [44]. In some patients, the GBS may be the first manifestation of tumor relapse.…”

“…In some patients, the GBS may be the first manifestation of tumor relapse. Treatment is the same as for the non-cancer related forms of GBS and consists of plasma exchange and IVIg neither of which is contraindicated in patients with cancer [44]. There is some evidence suggesting that patients with cancer-associated GBS have a worse neurological outcome compared to patients with GBS and no underlying cancer [44].…”