Rheumatoid factor: correlation with recurrence in transitional cell carcinoma of the bladder

Rheumatoid Factor: A Novel Determiner in Cancer History

Simple Summary

Rheumatoid factors are autoantibodies that characterize different autoimmune diseases, in particular rheumatoid arthritis, but that can also be found in the sera of the general healthy population. They have been mainly studied in the context of autoimmune diseases, but some evidence have suggested an association between their presence and the predisposition to develop cancer as well as a facilitation of cancer growth and progression in oncologic patients. In this review, for the first time we thus analyze and discuss the possible roles that these autoantibodies can assume in tumor history, from determiners of a heightened susceptibility of developing cancer to drivers of a reduced response to immunotherapies.

Abstract

The possible interplay between autoimmunity and cancer is a topic that still needs to be deeply explored. Rheumatoid factors are autoantibodies that are able to bind the constant regions (Fc) of immunoglobulins class G (IgGs). In physiological conditions, their production is a transient event aimed at contributing to the elimination of pathogens as well as limiting a redundant immune response by facilitating the clearance of antibodies and immune complexes. Their production can become persistent in case of different chronic infections or diseases, being for instance a fundamental marker for the diagnosis and prognosis of rheumatoid arthritis. Their presence is also associated with aging. Some studies highlighted how elevated levels of rheumatoid factors (RFs) in the blood of patients are correlated with an increased cancer risk, tumor recurrence, and load and with a reduced response to anti-tumor immunotherapies. In line with their physiological roles, RFs showed in different works the ability to impair in vitro anti-cancer immune responses and effector functions, suggesting their potential immunosuppressive activity in the context of tumor immunity. Thus, the aim of this review is to investigate the emerging role of RFs as determiners of cancer faith.

Rheumatoid factor isotypes and cancer prognosis

The relationship between rheumatoid factor (RF) and cancer was studied during a long-term health survey done in the Reykjavik area of Iceland since 1967. A total of 16,299 blood samples from 13,858 persons attending this health survey between 1974 and 1983 were screened for the presence of RF. In 1987, RF-positive participants in this study (n = 270) and matched RF-negative control subjects (n = 223) were evaluated for incidence and prognosis of cancer with information obtained from the comprehensive Icelandic Cancer Registry. The average observation time for this cohort was 9.3 years. Participants with raised immunoglobulin A RF in their original blood sample showed an increased risk of having cancer compared with both other members of the cohort and the national cancer incidence. Their total mortality was also higher during the study period. By contrast, patients with cancer and elevated immunoglobulin M RF before the diagnosis of cancer were more likely to survive than those who were immunoglobulin M RF negative. Cancer incidence in the RF-negative control group was not different from the expected national incidence of cancer in Iceland for that age group. It is suggested that elevation of immunoglobulin A RF is an adverse phenomenon in relation to cancer; elevation of immunoglobulin M RF is associated with a favorable prognosis.

Monoclonal antibody 486 P 3/12: a valuable bladder carcinoma marker for immunocytology

Monoclonal antibodies directed against tumor-associated antigens of bladder carcinoma were used to identify tumor cells in bladder washout specimens of 40 patients with bladder carcinoma (group 1), 41 with no bladder disease or with urinary tract infections (group 2), 41 who received long-term mitomycin C instillation therapy after excision of the tumors (group 3) and 39 who received no prophylaxis after excision of the tumors (group 4). In all groups the same bladder washout specimen was used for standard urinary cytological and immunocytological tests. True positive results were obtained in 90 per cent of the patients in group 1 according to our immunocytological criteria and in 43 per cent according to standard cytology studies. No urine specimens in group 2 (controls) were immunocytologically positive, while 16 of 41 in group 3 and 17 of 39 in group 4 were positive immunocytologically but only 4 and 5, respectively, were positive according to standard cytology studies. Further followup of these patients will show whether cells positive for monoclonal antibody 486 P 3/12 will permit early detection of recurrent bladder cancer and whether one can identify patients who require prophylaxis after removal of the superficial bladder tumors.

Lack of association of rheumatoid factor with either circulating immune complexes or tumor burden in cancer patients

The frequency of rheumatoid factor (RF) seropositivity and the frequency of association of RF with immune complex (IC) elevation were determined in 72 patients with a variety of solid tumors, in 78 patients with IC-associated diseases, 27 patients with non-IC-associated diseases, and in 31 normal healthy controls. The frequency of RF positivity in cancer patients (31%) was virtually identical to that in patients with IC-associated diseases (28%), and did not differ significantly from that seen in patients with non-IC-associated disease (15%). Whereas IC elevation was clearly related to tumor progress, RF was not. RF and IC status also appeared to be unrelated to each other, not only in cancer patients, but in patients with other diseases as well. The results do not support the concept that RF reflects progressive tumor growth or an immune response to IgG-containing immune complexes.

Rheumatoid factors in the sera of patient with gastrointestinal carcinoma

One hundred and nineteen patients with gastrointestinal (GI) malignancy (80 colorectal, 25 gastric and 14 pancreatic carcinoma) were studied for rheumatoid factors (RF), antinuclear antibodies (ANA) and immunoglobulin levels and the findings correlated with size of tumor, stage of disease and survival. Twenty three (19.3%) of the patients were RF seropositive compared to 5.7% of 70 matched controls (P = 0.02). In two thirds of the seropositive patients RF were detected prior to the initiation of treatment. The proportion of RF seropositivity increased significantly in patients with tumors larger than 4 cm and in patients with Stage D disease. The authors found a high incidence of ANA in the patients: 32.4% compared to 8% in normal subjects (P less than 0.01), but the proportion of RF in this group was not significantly different. Survival distributions of the RF positive cases were different from that of the other patients (18 versus 25 months median survival); however, this was not statistically significant. These findings indicate that RF in GI cancer patients sera is not rare and can be related mainly to "tumor load," although not considerably affecting survival.