title: Novel risk factors related to cancer in scleroderma.
abstract: OBJECTIVE
  Emerging data have shown an increased risk of malignancy among patients diagnosed with systemic sclerosis (SSc) so identification of risk factors linking both disorders might have prognostic implications. The aim of this study was to assess the clinical and treatment-related risk factors for cancer in a single-center cohort of patients with SSc.
  
  
  METHODS
  Demographic, clinical, capillaroscopic, immunological and treatment-related data from 432 consecutive SSc patients were retrospectively analyzed. Variables that reached significant association in the univariate analysis were entered into a logistic regression in order to identify independent risk factors for cancer.
  
  
  RESULTS
  Malignancy was diagnosed in 53 patients (12.2%). Fifty-eight neoplasms were identified, among which breast (n=15), lung (n=10) and hematologic (n=9) malignancies were the most prevalent. In 19 patients the diagnosis of both scleroderma and tumour was made in <3years apart. Cancer significantly decreased the probability of survival (OR=2.61; 95%CI 1.46-4.69; p=0.001). No association with age, sex, smoking, cutaneous subset or RNA polymerase-III antibodies was found. However, risk of cancer was directly associated with the presence of anti-PM/Scl antibodies (OR=3.90; 95%CI 1.31-11.61; p=0.014), and inversely related to aspirin use (OR=0.33; 95%CI 0.12-0.90; p=0.031), which remained as independent risk factors for cancer on multivariate analysis.
  
  
  CONCLUSIONS
  PM/Scl antibodies seem to be associated with a higher risk of cancer in scleroderma. In contrast, the use of aspirin is related to a lower risk of cancer in our series. More studies are needed to ascertain the role of anti PM/Scl antibodies and aspirin in the development of malignancy among patients with SSc.
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, C/Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain. Electronic address: david.bernal@salud.madrid.org.
authors.forename: David
authors.initials: D
authors.lastname: Bernal-Bello
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Guadalajara, Universidad de Alcalá, C/Donante de Sangre, s/n, 19002 Guadalajara, Spain. Electronic address: jgtena@movistar.es.
authors.forename: Jaime García
authors.initials: JG
authors.lastname: de Tena
authors.affiliation: Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: alguille@vhebron.net.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guillén-Del Castillo
authors.affiliation: Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: aselva@vhebron.net.
authors.forename: Albert
authors.initials: A
authors.lastname: Selva-O'Callaghan
authors.affiliation: Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: ecallejas@vhebron.net.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Callejas-Moraga
authors.affiliation: Department of Immunology, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: a.marin@vhebron.net.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Marín-Sánchez
authors.affiliation: Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: vfonollosa@vhebron.net.
authors.forename: Vicent
authors.initials: V
authors.lastname: Fonollosa-Pla
authors.affiliation: Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Spain, P. Vall d'Hebron, 119-129, 08035 Barcelona, Spain. Electronic address: cpsimeon@vhebron.net.
authors.forename: Carmen Pilar
authors.initials: CP
authors.lastname: Simeón-Aznar
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000473:pathology
keywords: Anti-PM/scl antibodies; Aspirin; Cancer; Exosome; Systemic sclerosis