Ankylosing spondylitis and the risk of cancer

Chang,Chih‑Cheng; Chang,Cheng‑Wei; Nguyen,Phung‑Anh  Alex; Chang,Tzu‑Hao; Shih,Ya‑Ling; Chang,Wen‑Ying; Horng,Jorng‑Tzong; Lee,Oscar   Kuang‑Sheng; Ho,Jennifer   Hui‑Chun

doi:10.3892/ol.2017.6368

Ankylosing spondylitis and the risk of cancer

Authors:
- Chih‑Cheng Chang
- Cheng‑Wei Chang
- Phung‑Anh Alex Nguyen
- Tzu‑Hao Chang
- Ya‑Ling Shih
- Wen‑Ying Chang
- Jorng‑Tzong Horng
- Oscar Kuang‑Sheng Lee
- Jennifer Hui‑Chun Ho
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Affiliations: Department of Internal Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan, R.O.C., Department of Information Management, Hsing Wu University, New Taipei 244, Taiwan, R.O.C., College of Medical Science & Technology, Taipei Medical University, Taipei 110, Taiwan, R.O.C., Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan, R.O.C., Department of Nursing, En Chu Kong Hospital, New Taipei 237, Taiwan, R.O.C., Department of Electrical Engineering, National Cheng‑Kung University, Tainan 701, Taiwan, R.O.C., Department of Biomedical Informatics, Asia University, Taichung 413, Taiwan, R.O.C., Institute of Clinical Medicine, National Yang‑Ming University, Taipei 112, Taiwan, R.O.C., Center for Stem Cell Research and Clinical Trial, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan, R.O.C.
Published online on: June 9, 2017 https://doi.org/10.3892/ol.2017.6368
Pages: 1315-1322

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Abstract

Cancer is a multifactorial disease, and imbalances of the immune response and sex‑associated features are considered risk factors for certain types of cancer. The present study aimed to assess whether ankylosing spondylitis (AS), an immune disorder that predominantly affects young adult men, is associated with an increased risk of cancer. Using the Taiwan National Health Insurance Research Database, a cohort of patients diagnosed with AS between 2000 and 2008 who had no history of cancer prior to enrollment was established (n=5,452). Age‑ and sex‑matched patients without AS served as controls (n=21,808). The results revealed that the overall incidence of cancer was elevated in patients with AS [standardized incidence ratio (SIR), 1.15; 95% confidence interval (CI), 1.03‑1.27]. AS carried an increased risk of hematological malignancy in both sexes, colon cancer in females and bone and prostate cancer in males. Young patients with AS (≤35 years) and patients with a Charlson comorbidity index (CCI) ≥2 experienced a higher incidence of cancer (males, SIR 1.92, and 95% CI 1.04‑3.26; females, SIR 2.00 and 95% CI 1.46‑5.50). The cancer risk was increased during the first 3 years following the diagnosis of AS (SIR 1.49, 95% CI 1.29‑1.71), and overall cancer‑free survival was significantly decreased in patients with AS patients of both sexes (P<0.0001). Therefore, AS was found to be associated with an increased risk of cancer. All AS patients must be screened for hematological malignancies, for prostate and bone cancer in males, and for colon cancer in females, particularly younger patients with a CCI ≥2.

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1	Braun J and Sieper J: Ankylosing spondylitis. Lancet. 369:1379–1390. 2007. View Article : Google Scholar : PubMed/NCBI
2	Chen HH, Chen TJ, Chen YM, Ying-Ming C and Chen DY: Gender differences in ankylosing spondylitis-associated cumulative healthcare utilization: A population-based cohort study. Clinics (Sao Paulo). 66:251–254. 2011. View Article : Google Scholar : PubMed/NCBI
3	Ho HH and Chen JY: Ankylosing spondylitis: Chinese perspective, clinical phenotypes, and associated extra-articular systemic features. Curr Rheumatol Rep. 15:3442013. View Article : Google Scholar : PubMed/NCBI
4	Selmi C: Diagnosis and classification of autoimmune uveitis. Autoimmun Rev. 13:591–594. 2014. View Article : Google Scholar : PubMed/NCBI
5	Bayen H, Bayen MC, De Curzon HP, Espinasse-Berrod MA, Manderieux N, Furia M and Campinchi R: Involvement of the posterior eye segment in HLA B27(+) iridocyclitis. Incidence. Value of surgical treatment. J Fr Ophtalmol. 11:561–566. 1988.(In French).
6	Davey-Ranasinghe N and Deodhar A: Osteoporosis and vertebral fractures in ankylosing spondylitis. Curr Opin Rheumatol. 25:509–516. 2013. View Article : Google Scholar : PubMed/NCBI
7	Atzeni F, Defendenti C, Ditto MC, Batticciotto A, Ventura D, Antivalle M, Ardizzone S and Sarzi-Puttini P: Rheumatic manifestations in inflammatory bowel disease. Autoimmun Rev. 13:20–23. 2014. View Article : Google Scholar : PubMed/NCBI
8	Siegel R, Naishadham D and Jemal A: Cancer statistics for Hispanics/Latinos, 2012. CA Cancer J Clin. 62:283–298. 2012. View Article : Google Scholar : PubMed/NCBI
9	Mantovani A, Allavena P, Sica A and Balkwill F: Cancer-related inflammation. Nature. 454:436–444. 2008. View Article : Google Scholar : PubMed/NCBI
10	Balkwill F and Mantovani A: Inflammation and cancer: Back to Virchow? Lancet. 357:539–545. 2001. View Article : Google Scholar : PubMed/NCBI
11	Hreggvidsdottir HS, Noordenbos T and Baeten DL: Inflammatory pathways in spondyloarthritis. Mol Immunol. 57:28–37. 2014. View Article : Google Scholar : PubMed/NCBI
12	Iqbal U, Nguyen PA, Syed-Abdul S, Yang HC, Huang CW, Jian WS, Hsu MH, Yen Y and Li YC: Is long-term use of benzodiazepine a risk for cancer? Medicine. 94:e4832015. View Article : Google Scholar : PubMed/NCBI
13	WHO International Classification of Disease codes. http://www.who.int/classifications/icd/en/November 17–2016
14	Hwang CY, Chen YJ, Lin MW, Chen TJ, Chu SY, Chen CC, Lee DD, Chang YT, Wang WJ and Liu HN: Cancer risk in patients with allergic rhinitis, asthma and atopic dermatitis: A nationwide cohort study in Taiwan. Int J Cancer. 130:1160–1175. 2012. View Article : Google Scholar : PubMed/NCBI
15	Feltelius N, Ekbom A and Blomqvist P: Cancer incidence among patients with ankylosing spondylitis in Sweden 1965–95: A population based cohort study. Ann Rheum Dis. 62:1185–1188. 2003. View Article : Google Scholar : PubMed/NCBI
16	Janssen F and Kunst AE: ICD coding changes and discontinuities in trends in cause-specific mortality in six European countries, 1950–99. Bull World Health Organ. 82:904–913. 2004.PubMed/NCBI
17	Baecklund E, Ekbom A, Sparén P, Feltelius N and Klareskog L: Disease activity and risk of lymphoma in patients with rheumatoid arthritis: Nested case-control study. BMJ. 317:180–181. 1998. View Article : Google Scholar : PubMed/NCBI
18	Kanai T, Nemoto Y, Tomita T, Totsuka T, Watanabe M and Hibi T: Persistent retention of colitogenic CD4+ memory T cells causes inflammatory bowel diseases to become intractable. Inflamm Bowel Dis. 15:926–934. 2009. View Article : Google Scholar : PubMed/NCBI
19	Mariette X, Matucci-Cerinic M, Pavelka K, Taylor P, van Vollenhoven R, Heatley R, Heatley R, Walsh C, Lawson R, Reynolds A and Emery P: Malignancies associated with tumour necrosis factor inhibitors in registries and prospective observational studies: A systematic review and meta-analysis. Ann Rheum Dis. 70:1895–1904. 2011. View Article : Google Scholar : PubMed/NCBI
20	Raaschou P, Frisell T and Askling J; ARTIS Study Group, : TNF inhibitor therapy and risk of breast cancer recurrence in patients with rheumatoid arthritis: A nationwide cohort study. Ann Rheum Dis. 74:2137–2143. 2015. View Article : Google Scholar : PubMed/NCBI
21	Au WY, Hawkins BR, Cheng N, Lie AK, Liang R and Kwong YL: Risk of haematological malignancies in HLA-B27 carriers. Br J Haematol. 115:320–322. 2001. View Article : Google Scholar : PubMed/NCBI
22	Wick RR, Nekolla EA, Gaubitz M and Schulte TL: Increased risk of myeloid leukaemia in patients with ankylosing spondylitis following treatment with radium-224. Rheumatology (Oxford). 47:855–859. 2008. View Article : Google Scholar : PubMed/NCBI
23	Weiss HA, Darby SC, Fearn T and Doll R: Leukemia mortality after X-ray treatment for ankylosing spondylitis. Radiat Res. 142:1–11. 1995. View Article : Google Scholar : PubMed/NCBI
24	Raymond AK and Jaffe N: Osteosarcoma multidisciplinary approach to the management from the pathologist's perspective. Cancer Treat Res. 152:63–84. 2009. View Article : Google Scholar : PubMed/NCBI
25	Spector TD, Ollier W, Perry LA, Silman AJ, Thompson PW and Edwards A: Free and serum testosterone levels in 276 males: A comparative study of rheumatoid arthritis, ankylosing spondylitis and healthy controls. Clin Rheumatol. 8:37–41. 1989. View Article : Google Scholar : PubMed/NCBI
26	Gordon D, Beastall GH, Thomson JA and Sturrock RD: Androgenic status and sexual function in males with rheumatoid arthritis and ankylosing spondylitis. Q J Med. 60:671–679. 1986.PubMed/NCBI
27	Alcalay M, Bontoux D, Maire P, Matuchansky C, Alcalay D and Tanzer J: HLA-B27 and colorectal cancer. N Engl J Med. 307:443–444. 1982. View Article : Google Scholar : PubMed/NCBI
28	Singh HJ, Nimarpreet K, Ashima, Das S, Kumar A and Prakash S: Study of bone mineral density in patients with ankylosing spondylitis. J Clin Diagn Res. 7:2832–2835. 2013.PubMed/NCBI
29	Feltelius N, Hvatum M, Brandtzaeg P, Knutson L and Hällgren R: Increased jejunal secretory IgA and IgM in ankylosing spondylitis: Normalization after treatment with sulfasalazine. J Rheumatol. 21:2076–2081. 1994.PubMed/NCBI
30	Van Praet L, Jacques P, Van den Bosch F and Elewaut D: The transition of acute to chronic bowel inflammation in spondyloarthritis. Nat Rev Rheumatol. 8:288–295. 2012. View Article : Google Scholar : PubMed/NCBI
31	Kanai T, Watanabe M and Hibi T: Systemically circulating colitogenic memory CD4+T cells may be an ideal target for the treatment of inflammatory bowel diseases. Keio J Med. 58:203–209. 2009. View Article : Google Scholar : PubMed/NCBI
32	Hemminki K, Liu X, Försti A, Ji J, Sundquist J and Sundquist K: Effect of autoimmune diseases on incidence and survival in subsequent multiple myeloma. J Hematol Oncol. 5:592012. View Article : Google Scholar : PubMed/NCBI
33	Hemminki K, Liu X, Ji J, Sundquist J and Sundquist K: Autoimmune disease and subsequent digestive tract cancer by histology. Ann Oncol. 23:927–933. 2012. View Article : Google Scholar : PubMed/NCBI
34	Fallah M, Liu X, Ji J, Försti A, Sundquist K and Hemminki K: Autoimmune diseases associated with non-Hodgkin lymphoma: A nationwide cohort study. Ann Oncol. 25:2025–2030. 2014. View Article : Google Scholar : PubMed/NCBI
35	Hemminki K, Liu X, Ji J, Försti A, Sundquist J and Sundquist K: Effect of autoimmune diseases on risk and survival in female cancers. Gynecol Oncol. 127:180–185. 2012. View Article : Google Scholar : PubMed/NCBI
36	Sun LM, Muo CH, Liang JA, Chang SN, Sung FC and Kao CH: Increased risk of cancer for patients with ankylosing spondylitis: A nationwide population-based retrospective cohort study. Scand J Rheumatol. 43:301–306. 2014. View Article : Google Scholar : PubMed/NCBI