Abdel-Wahab Noha, Tayar Jean H, Fa'ak Faisal, Sharma Gaurav, Lopez-Olivo Maria A, Yousif Abdelrahman, Shagroni Tasneam, Al-Hawamdeh Sami, Rojas-Hernandez Cristhiam M, Suarez-Almazor Maria E
Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Rheumatology & Rehabilitation Department, Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt.
Blood Adv. 2020 Apr 28;4(8):1746-1755. doi: 10.1182/bloodadvances.2020001557.
This review summarizes the evidence on antiphospholipid (aPL) antibodies and related thromboembolic events in patients with solid tumors. Data sources included Medline, EMBASE, Web of Science, PubMed ePubs, and the Cochrane Central Register of Controlled Trials through August 2019 without restrictions. Observational studies that evaluated patients with solid tumors for the presence of aPL antibodies were included. Data were extracted and quality was assessed by one reviewer and cross-checked by another. Thirty-three studies were identified. Gastrointestinal (GI) and genitourinary (GU) cancers were the most frequently reported. Compared with healthy patients, patients with GI cancer were more likely to develop anticardiolipin antibodies (risk ratio [RR], 5.1; 95% confidence interval [CI], 2.6-9.95), as were those with GU (RR, 7.3; 95% CI, 3.3-16.2) and lung cancer (RR, 5.2; 95% CI, 1.3-20.6). The increased risk for anti-β2-glycoprotein I or lupus anticoagulant was not statistically significant. Patients with lung cancer who had positive aPL antibodies had higher risk of developing thromboembolic events than those who had negative antibodies (RR, 3.8%; 95% CI, 1.2-12.2), while the increased risk in patients with GU cancer was not statistically significant. Deaths due to thromboembolic events were more common among patients with lung cancer who had elevated aPL antibodies. A limitation of this review is that the results are contingent on the reported information. We found an increased risk of developing aPL antibodies in patients with GI, GU, and lung cancers resulting in thromboembolic events and death. Further studies are needed to better understand the pathogenesis and development of aPL antibodies in cancer.
本综述总结了实体瘤患者中抗磷脂（aPL）抗体及相关血栓栓塞事件的证据。数据来源包括截至2019年8月的Medline、EMBASE、科学网、PubMed电子出版物以及Cochrane对照试验中央注册库，无任何限制。纳入评估实体瘤患者是否存在aPL抗体的观察性研究。数据由一名审阅者提取并评估质量，另一名审阅者进行交叉核对。共识别出33项研究。胃肠道（GI）和泌尿生殖系统（GU）癌症是最常报道的。与健康患者相比，GI癌症患者更易产生抗心磷脂抗体（风险比[RR]，5.1；95%置信区间[CI]，2.6 - 9.95），GU癌症患者（RR，7.3；95% CI，3.3 - 16.2）和肺癌患者（RR，5.2；95% CI，1.3 - 20.6）也是如此。抗β2糖蛋白I或狼疮抗凝物风险增加无统计学意义。aPL抗体呈阳性的肺癌患者发生血栓栓塞事件的风险高于抗体呈阴性的患者（RR，3.8%；95% CI，1.2 - 12.2），而GU癌症患者风险增加无统计学意义。aPL抗体升高的肺癌患者因血栓栓塞事件导致的死亡更为常见。本综述的一个局限性是结果取决于所报告的信息。我们发现GI、GU和肺癌患者产生aPL抗体的风险增加，从而导致血栓栓塞事件和死亡。需要进一步研究以更好地理解癌症中aPL抗体的发病机制和发展情况。
