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. 2023 Nov;82(2):368-378.
doi: 10.1007/s12020-023-03447-y. Epub 2023 Jul 13.

Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

Tongxin Xiao  1   2 , Rui Jiao  1   2 , Shengmin Yang  1 , Yi Wang  3 , Xue Bai  3 , Jingya Zhou  3 , Ran Li  1 , Linjie Wang  1 , Hongbo Yang  1 , Yong Yao  4 , Kan Deng  4 , Fengying Gong  1 , Hui Pan  1 , Lian Duan  5 , Huijuan Zhu  6
Affiliations

Incidence and risk factors of cancers in acromegaly: a Chinese single-center retrospective study

Tongxin Xiao et al. Endocrine. 2023 Nov.

Abstract

Purpose: To evaluate the incidence of malignancies in acromegaly and to identify risk factors for newly-diagnostic cancers, especially the excessive growth hormone (GH) and insulin-like growth factor-1 (IGF-1).

Methods: A retrospective cohort including 1738 consecutive hospitalized patients with acromegaly in a single referral center between 2012 and 2020 (mean follow-up 4.3 years). A gender- and age-matched case-control study (280 patients from the cohort) was performed for risk factor analysis.

Results: One hundred thirteen malignancies (67 diagnosed after acromegaly) were observed. The overall newly-diagnostic cancer risk of acromegaly was higher than the general population (standardized incidence ratio (SIR) 2.81; 95% CI 2.18-3.57). The risk of thyroid cancer (n = 33, SIR 21.42; 95% CI 13.74-30.08) and colorectal cancer (n = 8, SIR 3.17; 95% CI 1.37-6.25) was elevated. In the overall cohort, IGF-1 (ULN: 1.27 vs. 0.94, p = 0.057), GH (1.30 vs. 1.00 ng/ml, p = 0.12), and disease-controlled rate (34.9% vs. 45.9%, p = 0.203) at the last visit did not reach significance between patients with and without post-diagnostic cancer. In the case-control study, GH (1.80 vs. 0.90 ng/ml, p = 0.018) and IGF-1 (ULN: 1.27 vs. 0.91, p = 0.003) at the last visit were higher in patients with post-diagnostic cancers, with a lower disease-controlled rate. Elder age was a risk factor for cancer. Other metabolic comorbidities and the size of pituitary tumors were similar.

Conclusion: The risk of malignancies, especially thyroid cancer, was increased in patients with acromegaly in our center. More cancer screening should be considered when managing acromegaly, especially in patients with higher posttreatment GH and IGF-1.

Keywords: Acromegaly; Malignant tumors; Pituitary tumors; Risk factor; Thyroid cancer.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Malignancy types in acromegaly: overall cancers and newly-diagnostic cancers. a–c Overall cancers (n = 113, 28 males and 85 females) diagnosed before or after the diagnosis of acromegaly; d–f cancers diagnosed after the diagnosis of acromegaly (n = 67, 20 males and 47 females)
Fig. 2
Fig. 2
Diagnosed time of different malignant tumors: earlier or later than acromegaly
See this image and copyright information in PMC

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