Immune-Mediated Diseases Associated With Cancer Risks

Abstract

Importance: Immune regulation is important for carcinogenesis; however, the cancer risk profiles associated with immune-mediated diseases need further characterization.

Objective: To assess the prospective association of 48 immune-mediated diseases with the risk of total and individual cancers and the prospective association of organ-specific immune-mediated diseases with the risk of local and extralocal cancers.

Design, setting, and participants: This prospective cohort study used data from the UK Biobank cohort study on adults aged 37 to 73 years who were recruited at 22 assessment centers throughout the UK between January 1, 2006, and December 31, 2010, with follow-up through February 28, 2019.

Exposures: Immune-mediated diseases.

Main outcomes and measures: The association of immune-mediated diseases with risk of cancer was assessed with multivariable hazard ratios (HRs) and 95% CIs after adjusting for various potential confounders using time-varying Cox proportional hazards regression. Heterogeneity in the associations of organ-specific immune-mediated diseases with local and extralocal cancers was assessed using the contrast test method.

Results: A total of 478 753 participants (mean [SD] age, 56.4 [8.1] years; 54% female) were included in the study. During 4 600 460 person-years of follow-up, a total of 2834 cases of cancer were documented in 61 496 patients with immune-mediated diseases and 26 817 cases of cancer in 417 257 patients without any immune-mediated diseases (multivariable HR, 1.08; 95% CI, 1.04-1.12). Five of the organ-specific immune-mediated diseases were significantly associated with higher risk of local but not extralocal cancers: asthma (HR, 1.34; 95% CI, 1.14-1.56), celiac disease (HR, 6.89; 95% CI, 2.18-21.75), idiopathic thrombocytopenic purpura (HR, 6.94; 95% CI, 3.94-12.25), primary biliary cholangitis (HR, 42.12; 95% CI, 20.76-85.44), and autoimmune hepatitis (HR, 21.26; 95% CI, 6.79-66.61) (P < .002 for heterogeneity). Nine immune-mediated diseases were associated with an increased risk of cancers in the involved organs (eg, asthma with lung cancer [HR, 1.34; 95% CI, 1.14-1.57; P < .001] and celiac disease with small intestine cancer [HR, 6.89; 95% CI, 2.18-21.75; P = .001]); 13 immune-mediated diseases were associated with an increased risk of cancer in the near organs (eg, Crohn disease with liver cancer: [HR, 4.01; 95% CI, 1.65-9.72; P = .002]) or distant organs (eg, autoimmune hepatitis with tongue cancer [HR, 27.75; 95% CI, 3.82-199.91; P = .001]) or in different systems (eg, idiopathic thrombocytopenic purpura with liver cancer [HR, 11.96; 95% CI, 3.82-37.42; P < .001]).

Conclusions and relevance: In this cohort study, immune-mediated diseases were associated with an increased risk of total cancer. Organ-specific immune-mediated diseases had stronger associations with risk of local cancers than extralocal cancers. The associations for individual immune-mediated diseases were largely organ specific but were also observed for some cancers in the near and distant organs or different systems. Our findings support the role of local and systemic immunoregulation in cancer development.

Figure 1.. Total Cancers Associated With Immune-Mediated Diseases

^aModel 1 was adjusted for age at recruitment, sex, and ethnicity. ^bModel 2 was further adjusted for socioeconomic status (Townsend deprivation score), educational level, total physical activity, body mass index, waist-to-hip ratio, height, smoking status and intensity, alcohol status and consumption frequency, frequency of processed meat consumption, frequency of oily fish consumption, family history of cancer, vitamin supplements, and regular use of aspirin. ^cNecrotizing vasculopathies except vasculitis limited to the skin.

Figure 2.. Site-Specific Cancers Associated With Immune-Mediated Diseases

^aModel 1 was adjusted for age at recruitment, sex, and ethnicity. ^bModel 2 was further adjusted for socioeconomic status (Townsend deprivation score), educational level, total physical activity, body mass index, waist-to-hip ratio, height, smoking status and intensity, alcohol status and consumption frequency, frequency of processed meat consumption, frequency of oily fish consumption, family history of cancer, vitamin supplements, and regular use of aspirin.

Figure 3.. Association Profiles of Individual Immune-Mediated Diseases With Risk of Individual Cancers

Red represents a hazard ratio greater than 1; green, hazard ratio less than 1. ^aP = .002 to P < .05. ^bP < .002.