Abstract
BackgroundSystemic lupus erythematosus (SLE) is associated with increased risk of cancer and the mechanism remains unclear. Here, we examined the level of auto-antibodies and disease activity index scores in SLE patients with cancers and analyzed whether medications for SLE management might contribute to the higher cancer risk in SLE patients.MethodsIn this retrospective study, we carried out a nested case-control study in a large cohort of SLE patients. We screened 5858 SLE patients to identify the newly diagnosed and yet to be treated cancers. The following clinical features were evaluated: auto-antibodies levels, SLE disease activity index scores, and previous medication used for SLE management. Systemic glucocorticoid, cyclophosphamide, hydroxychloroquine (HCQ), methotrexate, and azathioprine were considered the main medication indices.ResultsOur analyses identified 51 SLE patients who also had cancer and 204 matched control patients who had SLE but not cancer. Of the 51 SLE patients, thyroid cancer (14/51, 27.45%), cervical cancer (10/51, 19.61%), and lung cancer (7/51, 13.73%) were the most common types. Our analyses did not reveal any significant differences in the levels of auto-antibodies in SLE patients with cancers relative to the control group. Further, we observed that disease activity was significantly lower in SLE patients with cancers relative to the matched control SLE group. There was no statistically significant association between the cancer risk and the use of systemic glucocorticoid, cyclophosphamide, methotrexate, or azathioprine. Importantly, the administration of HCQ was significantly lower in SLE patients suffering cancers relative to the cancer-free matched control group.ConclusionsOur analyses indicate that SLE patients with cancers might have a lower disease activity at the time of cancer diagnosis. HCQ was negatively associated with cancer risk in SLE patients. These findings highlight a potential and novel prevention strategy for SLE.
Highlights
Systemic lupus erythematosus (SLE) is associated with increased risk of cancer and the mechanism remains unclear
Eighteen patients that had been diagnosed with cancer prior to SLE diagnosis, 18 patients that had metastasis or received chemotherapy prior to hospital admission, and 274 patients with overlap syndrome were excluded from subsequent analyses
To the best of our knowledge, only a handful of studies have been done to explore the association between cancer and the drugs used in SLE, and the results were inconsistent [18,19,20,21]. In this large nested case-control study, we found that the SLE patients with cancer had lower disease activity and that HCQ was negatively associated with cancer risk in SLE patients
Summary
Systemic lupus erythematosus (SLE) is associated with increased risk of cancer and the mechanism remains unclear. Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder characterized by an aberrant production of auto-antibodies and a wide range of clinical manifestations and complications. Antinuclear antibodies (ANAs) refer to a broad class of antibodies targeting a wide range of cellular and nuclear components. These class of antibodies are generated as a result of loss of immune tolerance. For patients presenting with SLE, treatment with hydroxychloroquine (HCQ) is recommended unless contraindicated. In cases where the disease affects major organs or present refractory symptoms, treatment with systemic glucocorticoid (GC), cyclophosphamide (CTX), methotrexate (MTX), or azathioprine (AZA) is recommended. The mechanism underlying such an increase in cancer risk is not completely understood
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