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Hemostasis
Ferrata Storti Foundation
Haematologica 2020 Volume 105(2):490-497
Increased incidence of cancer in the follow-up of obstetric antiphospholipid syndrome within the NOH-APS cohort
Jean-Christophe Gris,1,2,3,4 Ève Mousty,5 Sylvie Bouvier,1,2,3 Sylvie Ripart,5 Éva Cochery-Nouvellon,1,3 Pascale Fabbro-Peray,6 Jonathan Broner,7 Vincent Letouzey5 and Antonia Pérez-Martin3,8
1Department of Hematology, University Hospital of Nîmes, Nîmes, France; 2Faculty of Pharmaceutical and Biological Sciences, University of Montpellier, Montpellier, France; 3UPRES EA2992 “Caractéristiques Féminines des Dysfonctions des Interfaces Vasculaires”, University of Montpellier, Montpellier, France; 4I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; 5Department of Gynecology and Obstetrics, University Hospital of Nîmes, Nîmes, France; 6Department of Biostatistics, Epidemiology, Public Health, Innovation and Methodology, University Hospital of Nîmes, Nîmes, France; 7Department of Internal Medicine, University Hospital of Nîmes, Nîmes, France and 8Department of Vascular Medicine, University Hospital of Nîmes, Nîmes, France
ABSTRACT
Malignancies can be associated with positive antiphospholipid anti- bodies but the incidence of cancer among women with the purely obstetric form of antiphospholipid syndrome (APS) is currently unknown. Our aim was to investigate the comparative incidence of cancers in women with a history of obstetric APS within a referral university hospi- tal-based cohort (NOH-APS cohort). We performed a 17-year observational study of 1,592 non-thrombotic women with three consecutive spontaneous abortions before the 10th week of gestation or one fetal death at or beyond the 10th week of gestation. We compared the incidence of cancer diagnosis during follow-up among the cohort of women positive for antiphospholipid antibodies (n=517), the cohort of women carrying the F5 rs6025 or F2 rs1799963 polymorphism (n=279) and a cohort of women with negative thrombophilia screening results (n=796). The annualized rate of cancer was 0.300% (0.20%-0.44%) for women with obstetric APS and their cancer risk was substantially higher than that of women with negative thrombophilia screening [adjusted hazard ratio (aHR) 2.483; 95% confidence interval (CI) 1.27-4.85]. The computed standardized incidence ratio for women with obstetric APS was 2.89; 95% CI: 1.89-4.23. Among antiphospholipid anti- bodies, lupus anticoagulant was associated with incident cancers (aHR 2.608; 95% CI: 1.091-6.236). Our cohort study shows that the risk of cancer is substantially higher in women with a history of obstetric APS than in the general population, and in women with a similar initial clinical history but negative for antiphospholipid antibodies.
Introduction
A number of case reports describe the association of antiphospholipid (aPL) anti- bodies with hematologic and solid organ malignancies.1 Especially in elderly patients, thrombotic events associated with aPL antibodies can be the first manifestation of malignancy.1 Cancer-associated monoclonal gammopathy of the IgM type can be accompanied by positive lupus anticoagulant (LA) or an anticardiolipin (aCL) IgM.2 Cancer and antiphospholipid antibody syndrome (APS) can coexist in sporadic cases, while some cancer patients with or without thrombosis may show transient positiv- ity for aPL antibodies;3 the most striking symptomatic clinical feature, catastrophic APS, has been described in cancer patients.4
Some reports suggest a significant incidence of malignancies in APS patients. Cancer was the second cause of death (13.9%), after bacterial infection, during the 10-year follow-up of 1,000 APS patients studied by the Euro-Phospholipid Project
Correspondence:
JEAN-CHRISTOPHE GRIS
jean.christophe.gris@chu-nimes.fr
Received: December 10, 2018. Accepted: May 16, 2019. Pre-published: May 17, 2019.
doi:10.3324/haematol.2018.213991
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