Scleroderma and Malignancy

Abstract

Background/ObjectivesDescribe clinical characteristics of malignancy-associated scleroderma in a regional population.MethodsScleroderma patients with current or past malignancy were prospectively identified from a cohort of 125 scleroderma subjects of a largely Hispanic population. Demographic information included scleroderma subtype, serologies, cancer diagnosis, age at diagnosis, co-morbid conditions, therapies, and survival outcomes.Results16.0% (20/125) of scleroderma patients were identified as having a malignancy. The mean age of malignancy onset and scleroderma onset were 55.6±10.3 and 52.7±12.9 years respectively (95% CI of difference: -4.6 <2.9< 10.4, p=0.44). Antinuclear antibody was positive in 70%, anticentromere antibody in 35.0%, and anti-topoisomerase antibodies in 25%. Tumor proportions were adenocarcinomas 55.0% (11/20) (1 gastric, 2 pancreatic, 1 lung, 2 thyroid, 5 breast), 15% (3/20) squamous cell carcinoma (1 skin, 1 uterine cervical, and 1 rectal), and 20% (4/20) benign tumors (2 meningiomas, 1 renal adenoma, 1 plasma cell). Age of onset of scleroderma greater than 42 years respectively accounted for 85% of all cancer cases. The standardized incidence ratio (SIR) was 2.0 (CI at 95%: 1.2<2<3.1), indicating 100% increase in cancer risk. Treatment of the malignancy did not resolve the scleroderma in any of the cases. Five-year survival after cancer diagnosis was 70.0%, although 2 of the survivors had tumor recurrence.ConclusionsMalignancy, especially adenocarcinoma, occurs frequently in scleroderma in minority populations with up to 16% of patients affected. High-risk patients are those with scleroderma-onset greater than 42 years in whom routine screening for common cancers should be undertaken.