FRI0207 CANCER INCIDENCE AND FEATURES IN ADULT VASCULITIS PATIENTS
Authors: R. C. Kardaş, E. C. Bolek, B. Y. Aktaş, S. Kiliçkap, O. Karadag
Journal: Annals of the Rheumatic Diseases (2020)

Background: Vasculitis, like other diseases with chronic inflammation, may be associated with increased cancer risk; possibly due to the inflammation triggering and advancing the neoplastic process. (1-3). Objectives: The primary objective of this study was to determine the incidence of cancer cases among systemic vasculitis cases followed in a university hospital clinic. Secondary objective was to analyze the relationship between the vasculitis and cancer subtypes and their demographical and clinical features. Methods: In this study, adult vasculitis patients followed at Hacettepe University Cancer Research, Diagnosis and Treatment Center (HUVAM) between October 2014 and May 2019 were reviewed for neoplastic development and cancer features. Standardized cancer incidence rate was calculated using the online International Agency for Research on Cancer GLOBOCAN database and the population data for Turkey published by Turkish Statistical Institute. Results: Among 684 patients with a mean age of 46.4±16.9 years and a median follow up duration of 29 months, 38 patients (5.6%) developed cancer. Colon (5 cases, 13%) and lung (4 cases, 11%) were the most commonly seen types of cancer. Among the patients with cancer, giant cell arteritis was the most common type of vasculitis (8 cases, 11%; Table 1). There was no statistically significant association between different cancer and vasculitis subtypes; however, there was increased trend for association between lung cancer and giant cell arteritis (data not shown). Table 1. Distribution of patients and number of cancer in each vasculitis subgroup Type of vasculitis Total With cancer N N %** Takayasu arteritis 123 4 3% Granulomatous polyangiitis 100 4 4% Giant cell arteritis 71 8 11% Vasculitis limited to skin 62 4 6% IgG4-related disease 41 1 2% Polyarteritis nodosa 34 1 3% Vasculitis secondary to CTD 32 2 6% Eosinophilic granulomatous polyangiitis 32 2 6% IgA vasculitis 30 2 7% Renal limited AAV 17 4 24% Buerger disease 17 1 6% Isolated aortitis 13 1 8% Microscopic polyangiitis 10 1 10% Cryoglobulinemic vasculitis 8 2 25% Drug-induced Vasculitis 1 1 100 Compared to the general population in Turkey, cancer incidence was four times higher (SIR: 4.1, 95% CI: 2.9–5.5, P &lt;0.001). Patients whom both the vasculitis and cancer diagnosis was within the same year, had a higher ratio of male patients (87%, P =0.01), had a higher rate of smoking (77%, P &lt;0.001) and had a worse rate of survival (median survival: 54 months, 95% CI: &lt;1 month–125.9 months, P =0.005). There was no association between cyclophosphamide (CYC) use and cancer development, with a low cumulative CYC dose among cancer patients (median: 2 g). Conclusion: The increase in the cancer incidence may indeed be due to chronic inflammation; however, VDI and BVAS scores during the last visit (median: &lt;0.1) indicate that non-inflammatory factor may play a role as the inflammatory damage caused by vasculitis in these patients seem to be low. Similar to other recent cohorts in the literature, there was no association between CYC usage and cancer development. In conclusion, compared to the general population, cancer incidence is significantly higher in patients with vasculitis and the timing of diagnosis between vasculitis and cancer may be associated with different clinical features. References: [1]Trinchieri G. Cancer and Inflammation: An Old Intuition with Rapidly Evolving New Concepts. Annu Rev Immunol. 2012;30(1):677–706. [2]Beyaert R, Beaugerie L, Van Assche G, Brochez L, Renauld J-C, Viguier M, et al. Cancer risk in immune-mediated inflammatory diseases (IMID). Mol Cancer. 2013 Aug 29;12(1):98. [3]Turesson C, Matteson EL. Malignancy as a comorbidity in rheumatic diseases. Rheumatology. 2013 Jan 1;52(1):5–14. Disclosure of Interests: None declared