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Open AccessArticle

Biphasic Temporal Relationship between Cancers and Systemic Sclerosis: A Clinical Series from Montpellier University Hospital and Review of the Literature

1
Montpellier’s School of Medicine, University of Montpellier, F-34967 Montpellier, France
2
Department of Internal Medicine—Multi-organ Diseases, Local Referral Center for Auto-Immune Diseases, Saint-Eloi University Hospital, F-34295 Montpellier, France
3
University of Montpellier, IRMB, Inserm, CHU Montpellier (Saint-Eloi University Hospital), U1183 Montpellier, France
4
Clinical Immunology and Osteoarticular Diseases, Therapeutic Unit, Lapeyronie University Hospital, F-34295 Montpellier, France
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Department of Biopathology, Biopathology Tumor Bank, Gui de Chauliac University Hospital, F-34295 Montpellier, France
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Department of Radiation Oncology, ICM-Val d’Aurelle, F-34298 Montpellier, France
7
INSERM, U1194, IRCM, F-34298 Montpellier, France
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Department of Dermatology, Saint-Eloi University Hospital, F-34295 Montpellier, France
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Department of Vascular Medicine, Saint-Eloi University Hospital, F-34295 Montpellier, France
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EA 2992 Dynamic Cardiovascular Inconsistencies, Montpellier University, Nîmes, 34095 Cedex 2, France
11
Department of Rheumatology, CHU and University of Montpellier, 34090 Montpellier, France
*
Author to whom correspondence should be addressed.
Léo Partouche and Radjiv Goulabchand participated equally to this work as first coauthors.
J. Clin. Med. 2020, 9(3), 853; https://doi.org/10.3390/jcm9030853
Received: 6 February 2020 / Revised: 17 March 2020 / Accepted: 17 March 2020 / Published: 20 March 2020
(This article belongs to the Section Immunology)
Cancer among patients with systemic sclerosis (SSc) would appear to be more prevalent than in the general population. Pathophysiological hypotheses are multiple, involving intertwined factors such as immune system antitumoral response, oxygen species dysregulation, and immunosuppressive treatments. We aimed to identify SSc patients with cancer monitored at our center, describing their clinical and immunological characteristics, such as cancer-specific outcomes. We focused in particular on the temporal relationships between cancer onset and SSc diagnosis. A retrospective study was conducted on SSc patients from Montpellier University Hospital from 2003 to 2018. Clinical characteristics and outcomes of each SSc patient with cancer were recorded. Fifty-five patients with SSc and at least one cancer was included (median age 56 years (47–66)), with a median follow-up time of 11 years (4–15). Sixty-four metachronous malignancies were identified (12 patients had two cancers). Among them, early-onset cancer occurrences (±5 years from SSc diagnosis) included 23 cancers (39% breast cancers, 13% lung cancers, and 13% gastro-intestinal tract cancers). Twenty-two cancers occurred 10 years (±5 years) after SSc diagnosis (14% breast cancers, 23% gastrointestinal (GI) tract cancers, and 18% lung cancers). Patients without any of the two autoantibodies (anti-centromere (ACA) and anti-topoisomerase (ATA-scl70) antibodies) were more prevalent in the early-onset cancer subgroup (14 vs. 6, p = 0.02). This study brought to light two peaks of cancer occurrence in SSc patients. Early-onset cancers were associated with SSc with a specific immunological signature. Late-onset cancers might be the consequence of a subtle interplay between repeated target organ inflammation, immunosuppressant use, mesenchymal cell dysfunction and subsequent genetic alterations. View Full-Text
Keywords: Systemic sclerosis; scleroderma; breast cancer; lung cancer; cancer occurrence Systemic sclerosis; scleroderma; breast cancer; lung cancer; cancer occurrence
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Partouche, L.; Goulabchand, R.; Maria, A.T.J.; Rivière, S.; Jorgensen, C.; Rigau, V.; Bourgier, C.; Bessis, D.; Le Quellec, A.; Quere, I.; Morel, J.; Guilpain, P. Biphasic Temporal Relationship between Cancers and Systemic Sclerosis: A Clinical Series from Montpellier University Hospital and Review of the Literature. J. Clin. Med. 2020, 9, 853.

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