Ontaneda Daniel, Fox Robert J
Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA.
Int J Neurosci. 2014 Jul;124(7):509-11. doi: 10.3109/00207454.2013.854208. Epub 2013 Oct 31.
Neuromyelitis optica (NMO) antibodies are commonly found in patients with NMO, a relapsing CNS inflammatory disorder. Recent evidence suggests that the NMO antibody may be a paraneoplastic marker. We evaluated this possibility using a health system-wide electronic medical record (EMR), allowing assessment of neoplasm both before and after the assessment of NMO seropositivity.
DESIGN/METHODS: An automated search of the Cleveland Clinic EMR was performed to identify patients with NMO serology testing (since 2006). Demographic, clinical, and imaging data were collected, including malignancy history.
A total of 41 patients NMO seropositive subjects were found. Average age at first clinical symptom was 38.7 years (SD 15.1), and 33 (80.5%) patients met formal criteria for NMO. Six malignancies were identified in five NMO seropositive patients (12.2%; age 48.7 years [SD 12.4] at presentation of NMO). Cancers included breast carcinoma (three cases), lymphoma, cervical carcinoma and leiomyosarcoma. The timing of malignancy diagnosis varied from 15 years prior to 14 years after the onset of neurologic symptoms. Among seropositive patients over age 50 years at the time of this review, malignancy was seen in 5/25 patients (20%). All five subjects fulfilled NMO clinical criteria.
A high prevalence of malignancy was found in NMO seropositive patients, although the sample size was small. These observations support the possibility of NMO as a paraneoplastic marker. If further studies confirm this relationship, clinicians may consider malignancy screening in individuals seropositive for NMO, particularly those over the age of 48.
视神经脊髓炎（NMO）抗体常见于患有NMO的患者中，NMO是一种复发性中枢神经系统炎性疾病。最近的证据表明，NMO抗体可能是一种副肿瘤标志物。我们使用全健康系统的电子病历（EMR）评估了这种可能性，从而能够在评估NMO血清阳性之前和之后对肿瘤进行评估。
设计/方法：对克利夫兰诊所的EMR进行自动搜索，以识别接受过NMO血清学检测的患者（自2006年起）。收集了人口统计学、临床和影像学数据，包括恶性肿瘤病史。
共发现41例NMO血清阳性患者。首次临床症状出现时的平均年龄为38.7岁（标准差15.1），33例（80.5%）患者符合NMO的正式标准。在5例NMO血清阳性患者中发现了6例恶性肿瘤（12.2%；NMO发病时年龄为48.7岁[标准差12.4]）。癌症包括乳腺癌（3例）、淋巴瘤、宫颈癌和平滑肌肉瘤。恶性肿瘤诊断时间从神经症状出现前15年到出现后14年不等。在本次审查时年龄超过50岁的血清阳性患者中，25例中有5例（20%）患有恶性肿瘤。所有5名受试者均符合NMO临床标准。
尽管样本量较小，但在NMO血清阳性患者中发现了较高的恶性肿瘤患病率。这些观察结果支持NMO作为副肿瘤标志物的可能性。如果进一步的研究证实这种关系，临床医生可能会考虑对NMO血清阳性个体进行恶性肿瘤筛查，尤其是那些年龄超过48岁的个体。
