Systematic review of observational studies reporting antiphospholipid antibodies in patients with solid tumors

Abstract

This review summarizes the evidence on antiphospholipid (aPL) antibodies and related thromboembolic events in patients with solid tumors. Data sources included Medline, EMBASE, Web of Science, PubMed ePubs, and the Cochrane Central Register of Controlled Trials through August 2019 without restrictions. Observational studies that evaluated patients with solid tumors for the presence of aPL antibodies were included. Data were extracted and quality was assessed by one reviewer and cross-checked by another. Thirty-three studies were identified. Gastrointestinal (GI) and genitourinary (GU) cancers were the most frequently reported. Compared with healthy patients, patients with GI cancer were more likely to develop anticardiolipin antibodies (risk ratio [RR], 5.1; 95% confidence interval [CI], 2.6-9.95), as were those with GU (RR, 7.3; 95% CI, 3.3-16.2) and lung cancer (RR, 5.2; 95% CI, 1.3-20.6). The increased risk for anti-β2-glycoprotein I or lupus anticoagulant was not statistically significant. Patients with lung cancer who had positive aPL antibodies had higher risk of developing thromboembolic events than those who had negative antibodies (RR, 3.8%; 95% CI, 1.2-12.2), while the increased risk in patients with GU cancer was not statistically significant. Deaths due to thromboembolic events were more common among patients with lung cancer who had elevated aPL antibodies. A limitation of this review is that the results are contingent on the reported information. We found an increased risk of developing aPL antibodies in patients with GI, GU, and lung cancers resulting in thromboembolic events and death. Further studies are needed to better understand the pathogenesis and development of aPL antibodies in cancer.

Association of neutrophil extracellular traps with the production of circulating DNA in patients with colorectal cancer

“…While aPL is present in 1%–5% of the general population, APS prevalence is 40–50/100,000 subjects ( Leal Rato et al., 2021 ). However, this prevalence can increase to 50% among elderly patients with chronic diseases ( Abdel-Wahab et al., 2020 ; Leal Rato et al., 2021 ). Several works report higher aPL levels in various hematological and solid tumors ( Gómez-Puerta et al., 2006 ; Islam, 2020 ), with the percentage of aPL-positive cancer patients varying from 5% to 70%.…”

“…Quantification of results is important, since there is a correlation between the rate of aCL (in particular IgG) and the risk of thrombosis. In view of this, low to moderate aCL levels are taken into consideration in contexts of repeated spontaneous miscarriages ( Abdel-Wahab et al., 2020 ).…”

“…These could play a crucial role in cirDNA production, notably in the degradation of the web-like chromatin derived from NETs in blood. In addition to NET’s contribution to the occurrence of thrombosis ( Wolach et al., 2018 ), anti-PL such as aCL were associated with thrombosis in various diseases, in particular with chronic diseases ( Abdel-Wahab et al., 2020 ; Leal Rato et al., 2021 ). While aPL thrombophilic process or direct association is unclear, it has been suggested that aPL plasma high level may trigger thrombosis in patients with cancer ( Gómez-Puerta et al., 2006 ; Islam, 2020 ).…”

Epidemiology of Antiphospholipid Syndrome in the General Population

“…aPL have also been associated with malignancy. A recent systemic review of observational studies reporting aPL frequency among patients with various solid tumors found that patients with gastrointestinal and lung cancers had 5 times the risk to develop aCL compared to healthy controls while those with genitourinary cancers had 7 times the risk [ 30 ]. Regarding hematologic malignancies, Pusterla et al reported among 100 patients with lymphoma, 24% were positive for aCL while 7% of them were positive for LAC [ 31 ].…”

Anti-Cancer Auto-Antibodies: Roles, Applications and Open Issues

“…Many of them are due to onco-neural auto-antibodies [ 137 ], whose molecular and pathogenic relationship with the original cancer is often difficult to identify. Anti-Ri antibodies [ 138 ], breast cancer anti-phospholipids antibodies [ 139 , 140 ], cerebellar degeneration [ 141 , 142 ], glomerular diseases [ 143 ], and lung cancer [ 144 ] are all conditions which still require a proper pathogenic explanation.…”