Incidence of Malignancy Prior to Antineutrophil Cytoplasmic Antibody-associated Vasculitis Compared to the General
Emma E van Daalen1,2, Chinar Rahmattulla3,4, Ron Wolterbeek3,4
1From the Department of Pathology, and the Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands. e.e.van_daalen@lumc.nl.
Objective:
Previous studies have reported an increased malignancy risk preceding antineutrophil cytoplasmic antibody-associated vasculitis (AAV), suggesting common pathogenic pathways in these 2 entities. However, the study results were conflicting and often limited to patients with granulomatosis with polyangiitis (GPA). Here, we study the malignancy risk prior to AAV diagnosis [either GPA or microscopic polyangiitis (MPA)] to elaborate on the putative association between malignancy and AAV.
Methods:
A total of 203 patients were selected for the current study. Malignancies prior to AAV diagnosis were identified using a nationwide pathology database, and their occurrence was verified by reviewing the medical files of 145 patients (71.4%). The malignancy incidence was compared to the general population by calculation of standardized incidence ratios (SIR), matching for sex, age, and time period. SIR were calculated for 2 intervals: < 2 years and ≥ 2 years prior to AAV diagnosis. Separate analyses were performed for GPA and MPA.
Results:
The overall risk for malignancy prior to AAV diagnosis was similar to that of the general population (SIR 0.96, 95% CI 0.55-1.57), as was true when risks were analyzed by malignancy type, including skin, bladder, kidney, lung, stomach, rectum, and uterus (SIR ranged from 1.64 to 4.14). We found no significant difference in malignancy risk between patients with GPA and MPA.
Conclusion:
Our findings do not support the hypothesis that preceding malignancies and AAV have a causal relationship or shared pathogenic pathways.
