Faisal Muhammad S, Burke Carol A, Liska David, Lightner Amy L, Leach Brandie, O'Malley Margaret, LaGuardia Lisa, Click Benjamin, Achkar J P, Kalady Matthew, Church J M, Mankaney Gautam
Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States.
World J Clin Oncol. 2022 Jan 24;13(1):49-61. doi: 10.5306/wjco.v13.i1.49.
Individuals with Lynch syndrome (LS) and hereditary non-polyposis colorectal cancer (HNPCC) are at increased risk of both colorectal cancer and other cancers. The interplay between immunosuppression, a comorbid inflammatory condition (CID), and HNPCC on cancer risk is unclear.
To evaluate the impact of CIDs, and exposure to monoclonal antibodies and immunomodulators, on cancer risk in individuals with HNPCC.
Individuals prospectively followed in a hereditary cancer registry with LS/HNPCC with the diagnosis of inflammatory bowel disease or rheumatic disease were identified. We compared the proportion of patients with cancer in LS/HNPCC group with and without a CID. We also compared the proportion of patients who developed cancer following a CID diagnosis based upon exposure to immunosuppressive medications.
A total of 21 patients with LS/HNPCC and a CID were compared to 43 patients with LS/HNPCC but no CID. Cancer occurred in 84.2% with a CID compared to 76.7% without a CID ( = 0.74) with no difference in age at first cancer diagnosis 45.5 ± 14.6 43.8 ± 7.1 years ( = 0.67). LS specific cancers were diagnosed in 52.4% with a CID 44.2% without a CID ( = 0.54). Nine of 21 (42.9%) patients were exposed to biologics or immunomodulators for the treatment of their CID. Cancer after diagnosis of CID was seen in 7 (77.8%) of exposed individuals 5 (41.7%) individuals unexposed to biologics/immunomodulators ( = 0.18). All 7 exposed compared to 3/5 unexposed developed a LS specific cancer. The exposed and unexposed groups were followed for a median 10 years and 8.5 years, respectively. The hazard ratio for cancer with medication exposure was 1.59 ( = 0.43, 95%CI: 0.5-5.1).
In patients with LS/HNPCC, the presence of a concurrent inflammatory condition, or use of immunosuppressive medication to treat the inflammatory condition, might not increase the rate of cancer occurrence in this limited study.
林奇综合征（LS）和遗传性非息肉病性结直肠癌（HNPCC）患者患结直肠癌和其他癌症的风险增加。免疫抑制、合并炎症性疾病（CID）和HNPCC之间对癌症风险的相互作用尚不清楚。
评估CID以及接触单克隆抗体和免疫调节剂对HNPCC患者癌症风险的影响。
在遗传性癌症登记处前瞻性随访的LS/HNPCC患者中，确定诊断为炎症性肠病或风湿性疾病的患者。我们比较了有和没有CID的LS/HNPCC组中患癌患者的比例。我们还比较了根据免疫抑制药物暴露情况在CID诊断后患癌的患者比例。
共将21例患有LS/HNPCC和CID的患者与43例患有LS/HNPCC但无CID的患者进行比较。有CID的患者中84.2%患癌，无CID的患者中76.7%患癌（P = 0.74），首次癌症诊断时的年龄无差异，分别为45.5±14.6岁和43.8±7.1岁（P = 0.67）。有CID的患者中52.4%被诊断为LS特异性癌症，无CID的患者中为44.2%（P = 0.54）。21例患者中有9例（42.9%）因CID接受了生物制剂或免疫调节剂治疗。在诊断CID后，接受生物制剂治疗的7例患者中有7例（77.8%）患癌，未接受生物制剂/免疫调节剂治疗的5例患者中有5例（41.7%）患癌（P = 0.18）。所有7例接受治疗的患者与未接受治疗的3/5患者相比，均发生了LS特异性癌症。接受治疗组和未接受治疗组的中位随访时间分别为10年和8.5年。药物暴露患癌的风险比为1.59（P = 0.43，95%CI：0.5 - 5.1）。
在这项有限的研究中，对于LS/HNPCC患者，并发炎症性疾病或使用免疫抑制药物治疗炎症性疾病可能不会增加癌症发生率。
