RESEARCH - Cancer in RA: occurrence, mortality, and associated factors in a South European population

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Semin Arthritis Rheum. 2008 Jun;37(6):388-97. Epub 2007 Oct 30.

Cancer in rheumatoid arthritis: occurrence, mortality, and associated

factors in a South European population.

Abásolo L, Júdez E, Descalzo MA, González-Alvaro I, Jover JA, Carmona

L; EMECAR Study Group.

Collaborators (68)

Alcazar L A, de C A, Sánchez J L A, Díez A A, Criado A B,

Gualda E B, Serrano M A B, Audera J B, Fabregat J B, Hernan G B,

Ortells L C, Fernández N C, E C, Mendez L C, Coro M C, Díaz J L C, E

C, Aresté J F, M F, Izquierdo M G, Meijide J A G, Gómez M C

G, Ubeda E G, Centeno E G, Vaquero C G, Fernández M J G, Gómez M L G,

Hernández T G, I GA, Gómez C GM, Delgado Y G, Masmitja J G, del Río A

H, A R I, Oyarzabal M V I, Palop M J, Mas A J, Navarro E J, Padro M L,

Longo F J L, Santmaria E L, Manzano J M, Ruiz F J M, Bernardo I M,

González L M, R M, San Idelfonso M M, Hernández A N, Español A P,

Callizo E P, Donate J Q, López P R, Redondo J R, Gómez M R, López M R,

Pardo R R, Alvarez J S, Sala R S, Rey Rey J S, Marsá X T, Martín M T,

Martín M C T, Garnica I U, de Diego J P V, M V, García V V, Montejo P

Z, Tabernero J Z.

Rheumatology Department, Hospital Clínico San , Madrid, Spain.

OBJECTIVES: To estimate the prevalence, incidence, mortality, and

predictors of cancer in patients with rheumatoid arthritis (RA).

METHODS: We compared the incidence of cancer and the mortality by

cancer in a cohort of 789 randomly selected RA patients (1999-2005)

with the expected ones in the general population. We estimated

standardized incidence ratios (SIR) and standardized mortality ratios

(SMR) by indirect age and sex standardization. Additionally, we

analyzed by generalized linear models the association of various

predictors with cancer incidence, obtaining incidence rate ratios

(IRR) with 95% confidence intervals (CI).

RESULTS: The SIR of cancer in RA is 1.23 (95% CI: 0.78-1.85). By

cancer type, there is an increased risk of leukemia, non-Hodgkin's

lymphoma, and lung cancer in RA compared with the general population

of the same sex and age. The SMR of cancer is 1.0 (95% CI: 0.53-1.7).

By cancer type, RA patients with lung or kidney cancer have higher

mortality than expected. Being male, elderly, with longstanding

disease, and having used any cytotoxic drugs apart from methotrexate

are confirmed as predictive factors for cancer. Additional independent

predictors are increases in blood leukocyte counts (IRR per 3000 u/mm3

increase: 1.88 (95% CI: 1.6 -2.1)) and decreases in serum hemoglobin

(IRR per 2 g/l decrease: 1.88 (95% CI: 1.19 -2.94)).

CONCLUSIONS: The overall incidence and mortality of cancer in RA is

not greater than the expected, although there is an increased risk of

hematopoietic and lung cancers in RA patients compared with the

general population. Hemoglobin and leukocyte counts may help to

identify RA patients at risk for cancer.

PMID: 17977580

http://www.ncbi.nlm.nih.gov/pubmed/17977580

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