Risk of malignancy in patients with systemic lupus erythematosus: Systematic review and meta-analysis - PubMed


Ann E Clarke 1 ,

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Review

. 2021 Dec;51(6):1230-1241.

doi: 10.1016/j.semarthrit.2021.09.009. Epub 2021 Sep 30.

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Review

Risk of malignancy in patients with systemic lupus erythematosus: Systematic review and meta-analysis

Ann E Clarke et al. Semin Arthritis Rheum. 2021 Dec.

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Abstract

Background: Malignancy is a potential comorbidity in patients with systemic lupus erythematosus (SLE). However, risk by malignancy type remains to be fully elucidated. We evaluated the risk of malignancy type in SLE patients in a systematic review and meta-analysis.

Methods: MEDLINE and EMBASE were searched from inception to July 2018 to identify observational studies that evaluated malignancy risk in adult SLE patients compared with the general population. Random-effects models were used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs). Heterogeneity was quantified using the I2 test.

Findings: Forty-one studies reporting on 40 malignancies (one overall, 39 site-specific) were included in the meta-analysis. The pooled RR for all malignancies from 3694 events across 80 833 patients was 1.18 (95% CI: 1.00-1.38). The risk of 24 site-specific malignancies (62%) was increased in SLE patients. For malignancies with ≥6 studies, non-Hodgkin lymphoma and Hodgkin lymphoma risk was increased >3-fold; myeloma and liver >2-fold; cervical, lung, bladder, and thyroid ≥1.5-fold; stomach and brain >1.3-fold. The risk of four malignancies (breast, uterine, melanoma, prostate) was decreased, whereas risk of 11 other malignancies did not differ between SLE patients and the general population. Heterogeneity ranged between 0% and 96%, and 63% were non-significant.

Interpretation: The risk of overall and some site-specific malignancies is increased in SLE compared with the general population. However, the risk for some site-specific malignancies is decreased or did not differ. Further examination of risk profiles and SLE patient phenotypes may support guidelines aimed at reducing malignancy risk.

Funding: AstraZeneca.

Systematic review registration: PROSPERO number: CRD42018110433.

Keywords: Cancer; Malignancy; Systematic Review With Meta-Analysis; Systemic Lupus Erythematosus.

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Conflict of interest statement

Declaration of Competing Interest AC has received consulting fees from AstraZeneca, BMS, Exagen Diagnostics, and GSK. NP, ZM, JL, LN, SL, and NE have received personal fees from AstraZeneca during the conduct of the study and outside the submitted work. XW and VB are employees of AstraZeneca. BD is an employee and shareholder of AstraZeneca. ERH was an employee of AstraZeneca at the time of study.

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