Autoantibody status in systemic sclerosis patients defines both cancer risk and survival with ANA negativity in cases with concomitant cancer having a worse survival

Abdulla Watad*, Dennis McGonagle, Nicola L. Bragazzi, Shmuel Tiosano, Doron Comaneshter, Yehuda Shoenfeld, Arnon D. Cohen, Howard Amital

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: A higher rate of cancer in systemic sclerosis (SSc) is recognized but the role of SSc-linked autoantibodies status (positive/negative and autoantibody specificities) in the survival of SSc-patients with cancer remains poorly understood. Methods: We utilized the Clalit-Health-Services medical database in a case-control study to evaluate the autoantibody status and specificities of SSc-patients with age- and sex-matched controls with regard to the prevalence of different cancer-subtypes and their impact on mortality. SSc-linked autoantibodies (ANA, anti-centromere, anti-RNP, anti-RNA polymerase III (RNAPIII) and anti-Scl-70) status was assessed in terms of cancer risk and outcome. Results: 2,431 SSc-patients and 12,377 age- and sex-matched controls were included. SSc-patients had a relative risk of cancer of 1.90 (95%CI 1.62-2.24, p < 0.0001) and tended to develop malignancies earlier than controls. RNAPIII and Scl-70 autoantibody were associated with an increased overall cancer risk and after SSc diagnosis risk of cancer, respectively. As expected, SSc-patients with cancer had a risk of death of 2.15 (1.65-2.79) in comparison to SSc-patients without cancer. ANA-positive SSc-patients with cancer had a better prognosis than ANA-negative cases (p = 0.0001). Despite the benefit of ANA-positive status on survival, the anti-Scl-70-positive subgroup with cancer had a significant negative impact on the survival compared to Scl-70-positive cases without cancer, whereas anti-RNAPIII and anti-centromere had no significant impact. Conclusion: ANA positivity is an independent predictor of favorable prognosis in SSc-patients with cancer, possibly suggesting that humoral autoimmunity in SSc with cancer may have some benefit. However, no survival benefit was discernible with the common autoantibodies.

Original languageEnglish
Article numbere1588084
JournalOncoImmunology
Volume8
Issue number6
DOIs
StatePublished - 3 Jun 2019

Funding

FundersFunder number
Israel Cancer Association

    Keywords

    • Systemic sclerosis
    • autoantibodies
    • autoimmune diseases
    • cancer
    • malignancy
    • scleroderma

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