Higher mortality risk from gynaecological neoplasms and non-Hodgkin's lymphoma in patients with systemic lupus erythematosus: an observational study from the Spanish National Registry

Abstract

Objective: To evaluate the impact of the different types of neoplasms and lineages on mortality of patients with SLE.

Methods: Retrospective and observational comparison of the neoplasm-related deaths in patients with SLE and the general Spanish population reported in the Spanish Hospital Discharge Database. To determine the impact of SLE on the risk of dying from each neoplasm lineage, a binary logistic regression considering age, female sex, tobacco and alcohol consumption, was performed.

Results: During 2016-2019, 139 531 in-hospital deaths from neoplasms were certified in Spain (91 in patients with SLE). Patients with SLE presented a lower mortality rate from solid organ neoplasms, (80.2% vs 91.1%, OR 0.393), linked to their lower risk of colorectal carcinoma (1.1% vs 10.8%, OR 0.110). By contrast, gynaecological neoplasms presented a higher risk (8.8% vs 3%, OR 3.039) in the deceased patients with SLE, associated with the higher frequency of vulvar neoplasms (2% vs 0.2%, OR 14.767) and cervical carcinomas (3.3% vs 0.5%, OR 3.809). Haematological neoplasm-related deaths were also more prevalent in patients with SLE (19.8% vs 8.9%, OR 2.546), mostly attributable to the higher proportion of deaths due to non-Hodgkin's lymphoma (11% vs 2.9%, OR 4.060) of B cell lineage (9.9% vs 2.5%, OR 4.133).

Conclusions: Patients with SLE present a higher risk of death from vulvar neoplasms, cervical carcinomas and B-cell non-Hodgkin's lymphoma in comparison with the general Spanish population. In addition to developing strategies that might help to attenuate their occurrence and impact, such as decreasing the immunosuppressive burden, specific early detection programmes for these conditions should be investigated and considered carefully.

Keywords: epidemiology; lupus erythematosus, systemic; mortality.

Figure 1

Solid organ neoplasms-related deaths for patients with SLE. The figure represents the risk of dying from solid organ neoplasms for patients with SLE, after adjustment for age, sex, alcohol and tobacco consumption, for each neoplasm lineage. The results are expressed in OR (dots) and 95% CI (bars).

Figure 2

Haematological neoplasms-related deaths for patients with SLE. The figure represents the risk of dying from haematological neoplasms for patients with SLE, after adjustment for age, sex, alcohol and tobacco consumption, for each neoplasm lineage. The results are expressed in OR (dots) and 95% CI (bars). NK, natural killer.