IgG4-related disease linked to increased risk for lymphoma, pancreatic cancer
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Patients with IgG4-related disease are at a higher risk for cancer — particularly pancreatic and lymphoma — compared with the general population, according to a meta-analysis published in Arthritis Research & Therapy.
“The risk of malignancies in patients with [IgG4-related disease (IgG4-RD)] has not been clarified,” Tingfeng Yu, of Sun Yat-sen Memorial Hospital, in Guangzhou, China, and colleagues wrote. “There are differing opinions on this issue. It should be noted that with ongoing further research, the initiation of immunomodulatory treatment and biologic agents has a potential therapeutic risk of increasing the incidence of malignancy by altering the normal function of immunosurveillance in addition to acting as an effective therapy in IgG4-RD patients.”
“Thus, understanding the baseline risk of malignancy is of great importance in patients with IgG4-RD,” they added. “To date, there has been no meta-analysis evaluating the risk of malignancy in IgG4-RD.”
To examine the risk for cancer among patients with IgG4-related disease, Yu and colleagues conducted a systematic review and meta-analysis of literature published from 2003 to 2020. The literature review included articles published in PubMed, Embase, Web of Science and SinoMed characterizing the associated risk for malignancy, as well as four specific cancer types — pancreatic, lung, gastric and lymphoma.
The researchers included a total of 10 studies in their analysis. They performed a random-effects model analysis to pool standardized incidence ratios (SIR) and 95% CI, as well as subgroup and sensitivity analyses to clarify the studies’ heterogeneity. In addition, they used Begg’s funnel plot and Egger’s linear regression test to examine bias within the meta-analysis, with a P value < .05 indicating the existence of publication bias.
According to the researchers, overall SIR estimates suggested an increased risk for overall cancer among patients with IgG4-RD (2.57; 95% CI, 1.72-3.84), compared with the general population. Meanwhile, specific SIRs for pancreatic cancer (4.07; 95% CI, 1.04-15.92) and lymphoma (69.17; 95% CI, 3.91-1,223.04) were particularly higher among those with IgG4-related disease versus the general population.
There were no significant associations between IgG4-related disease and respiratory (SIR = 2.14; 95% CI, 0.97-4.75) or gastric cancer (SIR = 0.95; 95% CI, 0.24-3.95).
The researchers identified four studies as the major sources of heterogeneity by sensitivity analysis. In addition, they found no evidence of publication bias.
“Taken together, IgG4-RD increases the risk of malignancy compared with the general population,” Yu and colleagues wrote. “Pancreatic cancer and lymphoma are associated with a high incidence rate in IgG4-RD patients according to the present data. Therefore, it is of great importance to screen for cancer in the management and diagnosis of IgG4-RD. However, we should be cautious when interpreting the results since most of the present studies are observational and the follow-up periods are relatively short for completely assessing the incidence rate of cancer.”
“The concrete mechanism of IgG4-RD in developing malignant disease is unclear,” they added. “Further higher-quality studies are needed to verify and elucidate the relationship between IgG4-RD and tumors.”
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