Daniela Esposito1,2, Oskar Ragnarsson1,2, Gudmundur Johannsson1,2, Daniel S Olsson1,2. 1. Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 2. Department of Endocrinology at Sahlgrenska University Hospital, Gothenburg, Sweden.
Abstract
CONTEXT: Whether cancer risk in acromegaly is increased remains controversial, and the risk of benign tumors has been little studied. OBJECTIVE: To investigate the incidence of benign and malignant tumors in acromegaly in a nationwide population-based study. METHODS: Adult patients diagnosed with acromegaly between 1987 and 2017 were identified in the Swedish National Patient Registry. The diagnoses of benign and malignant tumors were recorded. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for neoplasms with 95% CIs were calculated using the Swedish general population as reference. RESULTS: The study included 1296 patients (52% women). Mean (SD) age at diagnosis was 51.6 (14.7) years. Median (range) follow-up time was 11.7 (0-31) years. Overall, 186 malignancies were identified in acromegalic patients compared with 144 expected in the general population (SIR 1.3; 95% CI 1.1-1.5). The incidence of colorectal and anal cancer (SIR 1.5; 95% CI 1.0-2.2), and renal and ureteral cancer (SIR 4.0; 95% CI 2.3-6.5) was increased, whereas the incidence of malignancies of the respiratory system, brain, prostate, and breast was not. Only 3 cases of thyroid cancer were recorded. Mortality due to malignancies was not increased (SMR 1.1; 95% CI 0.9-1.4). Incidence of benign tumors was increased more than 2-fold (SIR 2.4; 95% CI 2.1-2.7). CONCLUSION: Patients with acromegaly had an increased risk of both benign and malignant tumors, including colorectal and anal cancer, and renal and ureteral cancer. Whether this is associated with acromegaly itself or due to more intensive medical surveillance remains to be shown.
CONTEXT: Whether cancer risk in acromegaly is increased remains controversial, and the risk of benign tumors has been little studied. OBJECTIVE: To investigate the incidence of benign and malignant tumors in acromegaly in a nationwide population-based study. METHODS: Adult patients diagnosed with acromegaly between 1987 and 2017 were identified in the Swedish National Patient Registry. The diagnoses of benign and malignant tumors were recorded. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) for neoplasms with 95% CIs were calculated using the Swedish general population as reference. RESULTS: The study included 1296 patients (52% women). Mean (SD) age at diagnosis was 51.6 (14.7) years. Median (range) follow-up time was 11.7 (0-31) years. Overall, 186 malignancies were identified in acromegalic patients compared with 144 expected in the general population (SIR 1.3; 95% CI 1.1-1.5). The incidence of colorectal and anal cancer (SIR 1.5; 95% CI 1.0-2.2), and renal and ureteral cancer (SIR 4.0; 95% CI 2.3-6.5) was increased, whereas the incidence of malignancies of the respiratory system, brain, prostate, and breast was not. Only 3 cases of thyroid cancer were recorded. Mortality due to malignancies was not increased (SMR 1.1; 95% CI 0.9-1.4). Incidence of benign tumors was increased more than 2-fold (SIR 2.4; 95% CI 2.1-2.7). CONCLUSION: Patients with acromegaly had an increased risk of both benign and malignant tumors, including colorectal and anal cancer, and renal and ureteral cancer. Whether this is associated with acromegaly itself or due to more intensive medical surveillance remains to be shown.
Authors: Margaret C S Boguszewski; Cesar L Boguszewski; Wassim Chemaitilly; Laurie E Cohen; Judith Gebauer; Claire Higham; Andrew R Hoffman; Michel Polak; Kevin C J Yuen; Nathalie Alos; Zoltan Antal; Martin Bidlingmaier; Beverley M K Biller; George Brabant; Catherine S Y Choong; Stefano Cianfarani; Peter E Clayton; Regis Coutant; Adriane A Cardoso-Demartini; Alberto Fernandez; Adda Grimberg; Kolbeinn Guðmundsson; Jaime Guevara-Aguirre; Ken K Y Ho; Reiko Horikawa; Andrea M Isidori; Jens Otto Lunde Jørgensen; Peter Kamenicky; Niki Karavitaki; John J Kopchick; Maya Lodish; Xiaoping Luo; Ann I McCormack; Lillian Meacham; Shlomo Melmed; Sogol Mostoufi Moab; Hermann L Müller; Sebastian J C M M Neggers; Manoel H Aguiar Oliveira; Keiichi Ozono; Patricia A Pennisi; Vera Popovic; Sally Radovick; Lars Savendahl; Philippe Touraine; Hanneke M van Santen; Gudmundur Johannsson Journal: Eur J Endocrinol Date: 2022-04-21 Impact factor: 6.558