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Brito-Zerón P, Kostov B, Fraile G, Caravia-Durán D, Maure B, Rascón FJ, Zamora M, Casanovas A, Lopez-Dupla M, Ripoll M, Pinilla B, Fonseca E, Akasbi M, de la Red G, Duarte-Millán MA, Fanlo P, Guisado-Vasco P, Pérez-Alvarez R, Chamorro AJ, Morcillo C, Jiménez-Heredia I, Sánchez-Berná I, López-Guillermo A, Ramos-Casals M. Characterization and risk estimate of cancer in patients with primary Sjögren syndrome. J Hematol Oncol 2017; 10:90. [PMID: 28416003 PMCID: PMC5392920 DOI: 10.1186/s13045-017-0464-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/05/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The purpose of this study is to characterize the risk of cancer in a large cohort of patients with primary Sjögren syndrome (SjS). METHODS We had analyzed the development of cancer in 1300 consecutive patients fulfilling the 2002 SjS classification criteria. The baseline clinical and immunological characteristics and systemic activity (ESSDAI scores) were assessed at diagnosis as predictors of cancer using Cox proportional hazards regression analysis adjusted for age at diagnosis and gender. The sex-and age-specific standardized incidence ratios (SIR) of cancer were estimated from 2012 Spanish mortality data. RESULTS After a mean follow-up of 91 months, 127 (9.8%) patients developed 133 cancers. The most frequent type of cancer was B-cell lymphoma (including 27 MALT and 19 non-MALT B-cell lymphomas). Systemic activity at diagnosis of primary SjS correlated with the risk of hematological neoplasia and cryoglobulins with a high risk of either B-cell or non-B-cell lymphoma subtypes. Patients with cytopenias had a high risk of non-MALT B-cell and non-B-cell cancer, while those with low C3 levels had a high risk of MALT lymphomas and those with monoclonal gammopathy and low C4 levels had a high risk of non-MALT lymphomas. The estimated SIR for solid cancer was 1.13 and 11.02 for hematological cancer. SIRs for specific cancers were 36.17 for multiple myeloma and immunoproliferative diseases, 19.41 for Hodgkin lymphoma, 6.04 for other non-Hodgkin lymphomas, 5.17 for thyroid cancer, 4.81 for cancers of the lip and oral cavity, and 2.53 for stomach cancer. CONCLUSIONS One third of cancers developed by patients with primary SjS are B-cell lymphomas. The prognostic factors identified at SjS diagnosis differed according to the subtype of B-cell lymphoma developed. Primary SjS is also associated with the development of some non-hematological cancers (thyroid, oral cavity, and stomach).
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital CIMA-Sanitas, Barcelona, Spain.,Laboratory of Autoimmune Diseases Josep Font, IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Belchin Kostov
- Transversal group for research in primary care, IDIBAPS, Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPSBE), Barcelona, Spain
| | - Guadalupe Fraile
- Department of Internal Medicine, Hospital Ramón y Cajal, Madrid, Spain
| | - Daniel Caravia-Durán
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Brenda Maure
- Department of Internal Medicine, Complejo Hospitalario Universitario, Vigo, Spain
| | | | - Mónica Zamora
- Department of Internal Medicine, Hospital Virgen de las Nieves, Granada, Spain
| | - Arnau Casanovas
- Department of Internal Medicine, Hospital Parc Taulí, Sabadell, Spain
| | | | - Mar Ripoll
- Department of Internal Medicine, Hospital Infanta Sofía, Madrid, Spain
| | - Blanca Pinilla
- Department of Internal Medicine, Hospital Gregorio Marañón, Madrid, Spain
| | - Eva Fonseca
- Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Gloria de la Red
- Department of Internal Medicine, Hospital Esperit Sant, Santa Coloma de Gramenet, Spain
| | | | - Patricia Fanlo
- Department of Internal Medicine, Hospital Virgen del Camino, Pamplona, Spain
| | - Pablo Guisado-Vasco
- Department of Internal Medicine, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
| | | | - Antonio J Chamorro
- Department of Internal Medicine, Hospital de Salamanca, Salamanca, Spain
| | - César Morcillo
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
| | | | - Isabel Sánchez-Berná
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Department of Internal Medicine, Hospital Virgen de las Nieves, Granada, Spain
| | | | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS, Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain. .,Department of Medicine, University of Barcelona, Barcelona, Spain.
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Alexander JS, Ganta VC, Jordan PA, Witte MH. Gastrointestinal lymphatics in health and disease. ACTA ACUST UNITED AC 2011; 17:315-35. [PMID: 20022228 DOI: 10.1016/j.pathophys.2009.09.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 09/28/2009] [Accepted: 09/28/2009] [Indexed: 12/17/2022]
Abstract
Lymphatics perform essential transport and immune regulatory functions to maintain homeostasis in the gastrointestinal (GI) system. Although blood and lymphatic vessels function as parallel and integrated systems, our understanding of lymphatic structure, regulation and functioning lags far behind that of the blood vascular system. This chapter reviews lymphatic flow, differences in lymphangiogenic and hemangiogenic factors, lymphatic fate determinants and structural features, and examines how altered molecular signaling influences lymphatic function in organs of the GI system. Innate errors in lymphatic development frequently disturb GI functioning and physiology. Expansion of lymphatics, a prominent feature of GI inflammation, may also play an important role in tissue restitution following injury. Destruction or dysregulation of lymphatics, following injury, surgery or chronic inflammation also exacerbates GI disease activity. Understanding the physiological roles played by GI lymphatics is essential to elucidating their underlying contributions to forms of congenital and acquired forms of GI pathology, and will provide novel approaches for therapy.
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Affiliation(s)
- J S Alexander
- Louisiana State University Health Sciences Center-Shreveport, Molecular and Cellular Physiology, Shreveport, LA, United States
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Lima I, Carneiro ASB, Amorim CA, Santiago MB. Hodgkin lymphoma as a complication of primary Sjögren's syndrome. Mod Rheumatol 2008; 18:200-2. [PMID: 18311531 DOI: 10.1007/s10165-008-0030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 11/07/2007] [Indexed: 11/28/2022]
Abstract
Sjögren's syndrome (SS) is a chronic autoimmune disease that is characterized by lymphocytic infiltration of the exocrine glands, mainly the salivary and lachrymal glands, usually manifesting with xerostomia and xerophthalmia. Around 50% of patients with primary SS develop systemic complications, lymphoma being the most feared of these. The majority of these neoplasias originate from B cells and are of the non-Hodgkin type. We describe here a rare case of SS in which the patient developed a Hodgkin lymphoma. We also review the literature on this subject.
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Affiliation(s)
- Isabella Lima
- Rheumatology Service, Hospital Santa Izabel (HSI), Salvador, Bahia, Brazil
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Ramos-Casals M, García-Carrasco M, Cervera R, Rosas J, Trejo O, de la Red G, Sánchez-Tapias JM, Font J, Ingelmo M. Hepatitis C virus infection mimicking primary Sjögren syndrome. A clinical and immunologic description of 35 cases. Medicine (Baltimore) 2001; 80:1-8. [PMID: 11204499 DOI: 10.1097/00005792-200101000-00001] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hepatitis C virus (HCV) infection is emerging as an extremely common and insidiously progressive liver disease that is often associated with several extrahepatic manifestations. In 1992, a possible relationship between Sjögren syndrome (SS) and patients with HCV infection was first postulated. Subsequently, several studies demonstrated that a "true" SS, with similar clinical and histologic features to those observed in primary SS, may occur in some patients with chronic HCV infection. We report the clinical and immunologic characteristics of 35 patients with chronic HCV infection and a well-documented diagnosis of SS. Compared with 60 patients with primary SS who tested negative for HCV antibodies, SS-HCV patients showed a higher mean age (65.9 yr versus 61.5 yr, p = 0.04), a lower prevalence of parotidomegaly (17% versus 47%, p = 0.004), and a higher prevalence of liver involvement (94% versus 3%, p < 0.001). Moreover, those patients with HCV-related SS showed a higher prevalence of anti-parietal cell gastric antibodies (31% versus 13%, p = 0.03), antimitochondrial antibodies (14% versus 2%, p = 0.02), cryoglobulinemia (60% versus 10%, p < 0.001), hypocomplementemia (60% versus 8%, p < 0.001), and a lower prevalence of anti-Ro/SS-A (17% versus 38%, p = 0.03). The "true" SS observed in some patients with HCV may be considered 1 of the extrahepatic manifestations of HCV, and we suggest that HCV infection can be considered as an exclusion criterion for the diagnosis of primary SS.
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Affiliation(s)
- M Ramos-Casals
- Systemic Autoimmune Diseases Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
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