FRI0293 Screening for Malignancies in Systemic Sclerosis Patients Positive for anti-RNA Polymerase III Antibodies: A Delphi Exercise among EUSTAR Experts
Authors: M.G. Lazzaroni, I. Cavazzana, P. Airo'
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> A temporal relationship between the onset of systemic sclerosis (SSc) and malignancies has been described in patients with anti-RNA polymerase III antibodies (anti-RNAP). Our analysis of the EUSTAR cohort (1) provided further information, highlighting the relationship of anti-RNAP with malignancies synchronous (±2 years) to the onset of SSc (OR 3.85, 95%CI 1.3–10.9). In particular, an increased rate of synchronous breast cancer was found (OR 20.2, 95%CI 1.4–355). These results suggest the possible need of a cancer screening program for these patients. <h3>Objectives</h3> To draw up a possible list of recommendations to guide the clinicians in every-day practice to screen anti-RNAP+ SSc patients for cancer. <h3>Methods</h3> A web-based Delphi approach was used to address the questions concerning possible screening for malignancies in anti-RNAP+ SSc patients. Prior to the first stage of Delphi exercise, the number of anti- RNAP+ patients needed to screen to find one synchronous malignancy was calculated using the results of the EUSTAR cohort. All EUSTAR centres were contacted: information on the analysis of the EUSTAR cohort was presented and centres were asked to participate to the exercise, voting on the opportunity of a screening for malignancies in anti-RNAP+ patients and its modality. In the second stage, questions that remained unsolved at the first step, and new suggestions from experts were re-proposed. Finally, possible recommendations were draft, and participants were asked to vote on them in stage 3 of the Delphi exercise. The level of agreement with each statement was voted using a 10-point visual analogue scale (10: fully agree). <h3>Results</h3> The number needed to screen to detect one synchronous malignancy in anti-RNAP+ patients in the EUSTAR cohort was 15; the number needed to screen to detect synchronous breast cancer was 22 (or 17, considering only female patients). Eighty-two experts from EUSTAR centers participated to the third stage of the Delphi exercise voting on possible recommendations on screening for synchronous cancer in anti-RNAP+ SSc patients: the results are shown in Table 1. <h3>Conclusions</h3> Most EUSTAR experts who participated to the Delphi exercise would recommend screening for synchronous malignancies at the moment of diagnosis in anti-RNAP+ SSc patients. In particular, screening for synchronous breast cancer in female patients, and for other malignancies, guided by clinical suspicion and patient age, would be recommended. Non-invasive tests may be considered in all patients. Although most experts agreed on the proposed statements, some degree of discordance was found on the use of PET/CT and the program of follow-up in subsequent years: in particular on how long should the tight surveillance lasts, and which exams are most indicated to be repeated. The experts agreed that prospective studies are needed to clarify these issues. <h3>References</h3> M.G. Lazzaroni et al. Anti-RNA Polymerase III Antibodies in Patients with Systemic Sclerosis: A Eustar Multicenter Collaborative Study. Ann Rheum Dis 2015;74:Suppl 2 88 doi:10.1136/annrheumdis-2015-eular.1728 <h3>Disclosure of Interest</h3> None declared