Association Between Rheumatoid Arthritis and Survival After Cancer: A Systematic Literature Review and Meta-analysis

Evidence on cancer outcomes in patients with rheumatoid arthritis (RA) is limited and conflicting. We conducted a systematic review to evaluate the association between RA and overall survival among patients with cancer.

A comprehensive literature search from inception through November 2024 identified observational studies evaluating mortality after cancer diagnosis in patients with RA. Study quality was assessed using the Newcastle-Ottawa Scale, and mortality estimates (RA with cancer vs cancer alone) were pooled using inverse variance weighting and random effects models in RevMan.

Twenty studies met our eligibility criteria. A total of 59,299 patients with both RA and any type of cancer were included, whereas 1,761,008 patients with cancer only were included. Compared with patients with cancer alone, those with RA and cancer did not have a significant difference in mortality (pooled hazard ratio [HR] 1.13; 95% confidence interval [CI] 0.90-1.42). There was significantly worse survival in patients with RA and lung cancer (HR 1.22; 95% CI 1.01-1.46), RA and hematologic malignancies (HR 1.20; 95% CI 1.04-1.37), and RA and breast cancer (pooled HR 1.41; 95% CI 1.22-1.63). Results for other cancer types were inconclusive across studies. All studies were of generally good quality, and no major publication bias was identified.

Patients with both RA and cancer overall do not experience poorer survival compared to patients with cancer alone. However, survival significantly worsens for patients with RA with lung, hematologic, or breast malignancies. Future prospective studies are warranted to elucidate underlying mechanisms and optimize cancer management strategies in RA.