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Carbonell C, Marcos M, Guillén-Del-Castillo A, Rubio-Rivas M, Argibay A, Marín-Ballvé A, Rodríguez-Pintó I, Baldà-Masmiquel M, Callejas-Moraga E, Colunga D, Sáez-Comet L, González-Echávarri C, Ortego-Centeno N, Marí-Alfonso B, Vargas-Hitos JA, Todolí-Parra JA, Trapiella L, Herranz-Marín MT, Freire M, Castro-Salomó A, Perales-Fraile I, Madroñero-Vuelta AB, Sánchez-García ME, Ruiz-Muñoz M, González-García A, Sánchez-Redondo J, de-la-Red-Bellvis G, Fernández-Luque A, Muela-Molinero A, Lledó GM, Tolosa-Vilella C, Fonollosa-Pla V, Chamorro AJ, Simeón-Aznar CP. Standardized incidence ratios and risk factors for cancer in patients with systemic sclerosis: Data from the Spanish Scleroderma Registry (RESCLE). Autoimmun Rev 2022; 21:103167. [PMID: 35931315 DOI: 10.1016/j.autrev.2022.103167] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 11/24/2022]
Abstract
AIM Patients with systemic sclerosis (SSc) are at increased risk of cancer, a growing cause of non-SSc-related death among these patients. We analyzed the increased cancer risk among Spanish patients with SSc using standardized incidence ratios (SIRs) and identified independent cancer risk factors in this population. MATERIAL AND METHODS Spanish Scleroderma Registry data were analyzed to determine the demographic characteristics of patients with SSc, and logistic regression was used to identify cancer risk factors. SIRs with 95% confidence intervals (CIs) relative to the general Spanish population were calculated. RESULTS Of 1930 patients with SSc, 206 had cancer, most commonly breast, lung, hematological, and colorectal cancers. Patients with SSc had increased risks of overall cancer (SIR 1.48, 95% CI 1.36-1.60; P < 0.001), and of lung (SIR 2.22, 95% CI 1.77-2.73; P < 0.001), breast (SIR 1.31, 95% CI 1.10-1.54; P = 0.003), and hematological (SIR 2.03, 95% CI 1.52-2.62; P < 0.001) cancers. Cancer was associated with older age at SSc onset (odds ratio [OR] 1.22, 95% CI 1.01-1.03; P < 0.001), the presence of primary biliary cholangitis (OR 2.35, 95% CI 1.18-4.68; P = 0.015) and forced vital capacity <70% (OR 1.8, 95% CI 1.24-2.70; P = 0.002). The presence of anticentromere antibodies lowered the risk of cancer (OR 0.66, 95% CI 0.45-0.97; P = 0.036). CONCLUSIONS Spanish patients with SSc had an increased cancer risk compared with the general population. Some characteristics, including specific autoantibodies, may be related to this increased risk.
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Affiliation(s)
- Cristina Carbonell
- Department of Internal Medicine, Hospital Universitario de Salamanca, Universidad de Salamanca-IBSAL, Salamanca, Spain
| | - Miguel Marcos
- Department of Internal Medicine, Hospital Universitario de Salamanca, Universidad de Salamanca-IBSAL, Salamanca, Spain.
| | - Alfredo Guillén-Del-Castillo
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Argibay
- Unit of Systemic Autoimmune Diseases and Thrombosis, Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo. Vigo, Pontevedra, Spain
| | - Adela Marín-Ballvé
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, IIS Aragón. Zaragoza, Spain
| | - Ignasi Rodríguez-Pintó
- Department of Internal Medicine, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, Spain
| | - Maria Baldà-Masmiquel
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Consorci Hospitalari de Vic. Vic, Barcelona, Spain
| | - Eduardo Callejas-Moraga
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | - Dolores Colunga
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Luis Sáez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Cristina González-Echávarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Norberto Ortego-Centeno
- Inst Invest Biosanitaria Ibs Granada. Department of Internal Medicine, Unit of Systemic Autoimmune Diseases. Department of Medicine, Facultad de Medicina. Hospital Universitario San Cecilio. Granada. Spain
| | - Begoña Marí-Alfonso
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | | | | | - Luis Trapiella
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Mayka Freire
- Unit of Autoimmune Diseases, Department of Internal Medicine. Hospital Clínico Universitario de Santiago. Santiago de Compostela, A Coruña, Spain
| | - Antoni Castro-Salomó
- Department of Internal Medicine. Hospital Universitario Sant Joan. Reus, Tarragona, Spain
| | - Isabel Perales-Fraile
- Department of Internal Medicine. Hospital Universitario Rey Juan Carlos. Móstoles, Madrid, Spain
| | | | | | - Manuel Ruiz-Muñoz
- Department of Internal Medicine. Hospital Universitario Fundación Alcorcón. Alcorcón, Madrid, Spain
| | | | - Jorge Sánchez-Redondo
- Department of Internal Medicine. Hospital Universitario de Móstoles. Móstoles, Madrid, Spain
| | - Gloria de-la-Red-Bellvis
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine. Fundació Hospital de l'Esperit Sant. Santa Coloma de Gramenet, Barcelona, Spain
| | | | - Alberto Muela-Molinero
- Department of Internal Medicine. Complejo Asistencial Universitario de León. León, Spain
| | - Gema-María Lledó
- Department of Autoimmune Diseases. Hospital Clinic. Barcelona, Spain
| | - Carles Tolosa-Vilella
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | - Vicent Fonollosa-Pla
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Antonio-Javier Chamorro
- Department of Internal Medicine, Hospital Universitario de Salamanca, Universidad de Salamanca-IBSAL, Salamanca, Spain
| | - Carmen-Pilar Simeón-Aznar
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Wang S, Guo XZ, Xu SX, Qi XS. Risk and treatment of non-hepatic cancers in patients with cirrhosis. Shijie Huaren Xiaohua Zazhi 2020; 28:655-659. [DOI: 10.11569/wcjd.v28.i15.655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Patients with cirrhosis are at a high risk for hepatocellular carcinoma. However, it remains controversial about whether or not there is a high risk for non-hepatic cancers in patients with liver cirrhosis. Additionally, the management of non-hepatic cancers in cirrhotic patients is a clinical challenge, because the use of surgery and anticancer drugs is often compromised by the presence of liver dysfunction. This editorial aims to briefly summarize the findings on the risk and management of non-hepatic cancers in patients with cirrhosis.
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Affiliation(s)
- Shuo Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Xiao-Zhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Shi-Xue Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, China Medical University, Shenyang 110122, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Abstract
(Table is included in full-text article.)PBC in the advanced stage, corresponding to PBC stage IV, was shown in the past to be associated with an increased incidence of hepatocellular carcinoma (HCC). There is currently a debate, about the increase in incidence of extrahepatic malignancies, as some, but not all studies reported these neoplasms to be more common, especially breast cancer, irrespective of the PBC disease stage. In this issue of the journal a case series is reported on the incidence of various malignancies in a cohort of 212 patients with PBC from Greece. Considering as reference the cancer registries of another Mediterranean Country, like Italy, we could suggest that the incidence of extrahepatic malignancy, breast included, is not increased in PBC patients. Indeed, a more accurate analysis of the literature, shows that higher incidence of breast cancer were reported only for PBC patients evaluated in the 1970s and early 1980s, for whom a contribution of immunosuppressive agents, largely under investigation at that time, could be speculated. PBC patients do not need, therefore, to be submitted to stricter surveillance programs for extrahepatic cancer than the general population. As far as the development of HCC is concerned, instead, PBC patients should undergo the usual surveillance reserved to other categories of cirrhotic patients, according to published guidelines for the management of HCC. Such surveillance should start only when PBC patients have reached disease stage IV (frank cirrhosis).
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Xu L, Sakalian M, Shen Z, Loss G, Neuberger J, Mason A. Cloning the human betaretrovirus proviral genome from patients with primary biliary cirrhosis. Hepatology 2004; 39:151-6. [PMID: 14752833 DOI: 10.1002/hep.20024] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with primary biliary cirrhosis (PBC) have both serologic and tissue evidence of infection. A recently identified human betaretrovirus was originally cloned from the biliary epithelium cDNA library of a patient with PBC. By conducting a BLASTN search, the initial partial pol gene fragment was found to have 95% to 97% nucleotide homology with mouse mammary tumor virus (MMTV) and with retrovirus sequences derived from human breast cancer samples. Using an anti-p27(CA) MMTV antibody, viral proteins were detected in the perihepatic lymph nodes but not in liver tissue samples from patients with PBC, suggesting a higher viral burden in lymphoid tissue. Therefore, in the current study, we used lymph node DNA to clone the proviral genome of the human betaretrovirus from two patients with PBC using a polymerase chain reaction (PCR) walking methodology with conserved primers complementary to MMTV. The human betaretrovirus genome contains five potential open reading frames (ORF) for Gag, protease (Pro), polymerase (Pol), envelope (Env), and superantigen (Sag) proteins that are collinear with their counterparts in MMTV. Alignment studies performed with characterized MMTV and human breast cancer betaretrovirus amino acid sequences revealed a 93% to 99% identity with the p27 capsid proteins, a 93% to 97% identity with the betaretrovirus envelope proteins, and a 76% to 85% identity with the more variable superantigen proteins. Phylogenetic analysis of known betaretrovirus superantigen proteins showed that the human and murine sequences did not cluster as two distinct species. In conclusion, human betaretrovirus nucleic acid sequences have been cloned from patients with PBC. They share marked homology with MMTV and human breast cancer-derived retrovirus sequences.
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Affiliation(s)
- Lizhe Xu
- Section of Gastroenterology and Hepatology, Ochsner Clinic Foundation, New Orleans, LA, USA
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Tanaka A, Leung PS, Kenny TP, Au-Young J, Prindiville T, Coppel RL, Ansari AA, Gershwin ME. Genomic analysis of differentially expressed genes in liver and biliary epithelial cells of patients with primary biliary cirrhosis. J Autoimmun 2001; 17:89-98. [PMID: 11488641 DOI: 10.1006/jaut.2001.0522] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The characterization of differentially expressed genes provides a powerful tool for identifying molecules that may be involved in the pathogenesis of disease. We have used two independent techniques to identify overexpressed transcripts in bile duct cells and in liver from patients with primary biliary cirrhosis (PBC). In the first method, we used suppressive subtractive hybridization to compare mRNA from isolated PBC bile duct epithelial cells (BECs) to normal BECs and identified 71 clones as transcribed at higher levels in PBC-BECs. Amongst these clones, 62/71 had matches in a non-redundant nucleotide database and 9/71 had matches in an EST database. Of the 62 clones, 51/62 include a complexity of genes involved in cell proliferation, signal transduction, transcription regulation, RNA processing, carbohydrate metabolism and hypothetical/unknown proteins; 4/62 were identified as interstitial collagenase and collagenase precursors, 4/62 as ribosomal proteins, 3/62 as mitochondrial DNA. The mitochondrial cDNA sequences included cytochrome c oxidase, Wnt-13, and the pHL gene, a c-myc oncogene containing coxIII sequence. In the second method, we constructed cDNA libraries from three different PBC livers and sequenced a total of 12,324 independent clones. These 12,324 clones underwent virtual subtraction with 2,814,148 independent clones from Incyte LifeSeq libraries. Twenty one sequences were identified as unique to PBC liver. Collectively, these approaches identified a number of genes involved in signalling, RNA processing, mitochondrial function, inflammation, and fibrosis. Interestingly, both Wnt-13 and Notch transcripts are overexpressed in PBC liver. Further studies are needed to focus on the significance of these genes during the natural history of disease.
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Affiliation(s)
- A Tanaka
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Internal Medicine, University of California at Davis, CA 95616, USA
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