SpringerLink
Log in

Cancer incidence in Behçet’s disease

  • Original Article
  • Published:
Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

Previous studies demonstrated an increased cancer risk in autoimmune diseases. Behçet’s disease (BD) was also reported to be associated with an increased risk of cancer, although the data is limited.

Aims

In this study, we aimed to assess cancer incidence in a large cohort of BD patients and to compare with the data of the same age and gender groups.

Methods

The study cohort consisted of BD patients of > 18 years of age who were prospectively recorded in the Hacettepe University Vasculitis Center. Data on any cancer was collected from the patient files. Cancer incidence was compared with age- and gender-specific cancer incidence rates of the normal population retrieved from the 2014 Turkish National Cancer Registry (TNCR) data using standardized incidence rates (SIR).

Results

Totally, 451 adult cases with BD were included. The median age of the cohort was 43 (20–75), and 52.5% of the patients were males. Eleven cancer cases were observed during a median of 124 months follow-up. Behçet’s disease was associated with an increase in cancer risk compared with expected counts in the corresponding age and sex group (SIR 2.84, 95% CI 1.50–4.94, p < 0.001). Patients with papulopustular lesions had a trend toward a decreased risk of cancer (p = 0.060), and patients using azathioprine had a significantly decreased cancer risk (p = 0.031).

Conclusion

This study revealed BD patients had approximately three times increased cancer risk compared with corresponding age and sex groups. Besides the routine care, increased attention for cancer surveillance is required in the follow-up of BD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sakane T, Takeno M, Suzuki N, Inaba G (1999) Behçet’s disease. N Engl J Med 341(17):1284–1291

    CAS  PubMed  Google Scholar 

  2. Mendes D, Correia M, Barbedo M et al (2009) Behçet’s disease – a contemporary review. J Autoimmun 32(3):178–188

    CAS  PubMed  Google Scholar 

  3. Yazici H, Seyahi E, Hatemi G, Yazici Y (2018) Behçet syndrome: a contemporary view. Nat Rev Rheumatol 14:107–119

    CAS  PubMed  Google Scholar 

  4. Greco A, De Virgilio A, Ralli M et al (2018) Behçet’s disease: new insights into pathophysiology, clinical features and treatment options. Autoimmun Rev 17(6):567–575

    CAS  PubMed  Google Scholar 

  5. de Chambrun MP, Wechsler B, Geri G et al (2012) New insights into the pathogenesis of Behcet’s disease. Autoimmun Rev 11(10):687–698

    Google Scholar 

  6. Shalapour S, Karin M (2015) Immunity, inflammation, and cancer: an eternal fight between good and evil. J Clin Invest 125(9):3347–3355

    PubMed  PubMed Central  Google Scholar 

  7. Zamarron BF, Chen W (2011) Dual roles of immune cells and their factors in cancer development and progression. Int J Biol Sci 7(5):651–658

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Landskron G, De la Fuente M, Thuwajit P et al (2014) Chronic inflammation and cytokines in the tumor microenvironment. J Immunol Res 2014:149185–149185

    PubMed  PubMed Central  Google Scholar 

  9. Grivennikov SI, Greten FR, Karin M (2010) Immunity, inflammation, and cancer. Cell 140(6):883–899

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Wang J-C, Xu Y, Huang Z-M, Lu X-J (2018) T cell exhaustion in cancer: mechanisms and clinical implications. J Cell Biochem 119(6):4279–4286

    CAS  PubMed  Google Scholar 

  11. Davoodzadeh Gholami M, Kardar GA, Saeedi Y et al (2017) Exhaustion of T lymphocytes in the tumor microenvironment: significance and effective mechanisms. Cell Immunol 322:1–14

    CAS  PubMed  Google Scholar 

  12. Erez N, Truitt M, Olson P, Hanahan D (2010) Cancer-associated fibroblasts are activated in incipient neoplasia to orchestrate tumor-promoting inflammation in an NF-KB-dependent manner. Cancer Cell 17(2):135–147

    CAS  PubMed  Google Scholar 

  13. Schoppmann SF, Birner P, Stöckl J et al (2002) Tumor-associated macrophages express lymphatic endothelial growth factors and are related to peritumoral lymphangiogenesis. Am J Pathol 161(3):947–956

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Chang SH, Park JK, Lee YJ et al (2014) Comparison of cancer incidence among patients with rheumatic disease: a retrospective cohort study. Arthritis Res Ther 16(4):428

    PubMed  PubMed Central  Google Scholar 

  15. Jung YS, Han M, Kim DY et al (2017) Cancer risk in Korean patients with Behçet’s disease: a nationwide population-based study. PLoS One 12(12):e0190182

    PubMed  PubMed Central  Google Scholar 

  16. Wang L-H, Wang W-M, Hsu S-M et al (2015) Risk of overall and site-specific cancers in Behçet disease: a nationwide population-based study in Taiwan. J Rheumatol 42(5):879–884

    CAS  PubMed  Google Scholar 

  17. Na SJ, Kang MJ, Yu DS et al (2018) Cancer risk in patients with Behçet disease: a nationwide population-based dynamic cohort study from Korea. J Am Acad Dermatol 78(3):464–470.e462

    PubMed  Google Scholar 

  18. Lin Y, Li G, Zheng W et al (2014) Behcet’s disease associated with malignancy: a report of 41 Chinese cases. Int J Rheum Dis 17(4):459–465

    PubMed  Google Scholar 

  19. Cengiz M, Altundag K, Zorlu F et al (2001) Malignancy in Behçet’s disease: a report of 13 cases and a review of the literature. Clin Rheumatol 20:239–244

    CAS  PubMed  Google Scholar 

  20. Tada Y, Koarada S, Haruta Y et al (2006) The association of Behcet’s disease with myelodysplastic syndrome in Japan: a review of the literature. Clin Exp Rheumatol 24(5):S115

    CAS  PubMed  Google Scholar 

  21. Cancer statistics of Turkey. (Ed.^(Eds) (2014)

  22. Karadag O, Erden A, Batu ED et al (2017) FRI0342 distribution of vasculitides in Eastern Mediterranean: results of a prospective cohort. Ann Rheum Dis 76(Suppl 2):616

    Google Scholar 

  23. International Study Group for Behçet’s D (1990) Criteria for diagnosis of Behcet’s disease. Lancet 335(8697):1078–1080

    Google Scholar 

  24. Guven DC, Dizdar O, Akman AC et al (2019) Evaluation of cancer risk in patients with periodontal diseases. Turk J Med Sci 49(3):826–831

    PubMed  PubMed Central  Google Scholar 

  25. Dizdar O, Hayran M, Guven DC et al (2017) Increased cancer risk in patients with periodontitis. Curr Med Res Opin 33(12):2195–2200

    PubMed  Google Scholar 

  26. McGonagle D, McDermott MF (2006) A proposed classification of the immunological diseases. PLoS Med 3(8):e297–e297

    PubMed  PubMed Central  Google Scholar 

  27. Pineton de Chambrun M, Wechsler B, Geri G et al (2012) New insights into the pathogenesis of Behçet’s disease. Autoimmun Rev 11(10):687–698

    CAS  PubMed  Google Scholar 

  28. Tong B, Liu X, **ao J, Su G (2019) Immunopathogenesis of Behcet’s disease. Front Immunol 10:665–665

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Giza M, Koftori D, Chen L, Bowness P (2018) Is Behçet’s disease a ‘class 1-opathy’? The role of HLA-B*51 in the pathogenesis of Behçet’s disease. Clin Exp Immunol 191(1):11–18

    CAS  PubMed  Google Scholar 

  30. Ekinci NS, Alpsoy E, Karakas AA et al (2010) IL-17A has an important role in the acute attacks of Behçet’s disease. J Invest Dermatol 130(8):2136–2138

    CAS  PubMed  Google Scholar 

  31. Alpsoy E (2016) Behçet’s disease: a comprehensive review with a focus on epidemiology, etiology and clinical features, and management of mucocutaneous lesions. J Dermatol 43(6):620–632

    CAS  PubMed  Google Scholar 

  32. Talaat RM, Sibaii H, Bassyouni IH, El-Wakkad A (2019) IL-17, IL-10, IL-6, and IFN-γ in Egyptian Behçet’s disease: correlation with clinical manifestations. Eur Cytokine Netw 30(1):15–22

    CAS  PubMed  Google Scholar 

  33. Palipudi KM, Gupta PC, Sinha DN et al (2012) Social determinants of health and tobacco use in thirteen low and middle income countries: evidence from global adult tobacco survey. PLoS One 7(3):e33466–e33466

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Soy M, Erken E, Konca K, Ozbek S (2000) Smoking and Behcet’s disease. Clin Rheumatol 19(6):508–509

    CAS  PubMed  Google Scholar 

  35. Silveira L (1992) Smoking controls symptomatology of Behçet’s disease. Arthritis Rheum 35:12S

    Google Scholar 

  36. Yu K-H, Kuo C-F, Huang LH et al (2016) Cancer risk in patients with inflammatory systemic autoimmune rheumatic diseases: a Nationwide population-based dynamic cohort study in Taiwan. Medicine 95(18):e3540–e3540

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Aktas Cetin E, Cosan F, Cefle A, Deniz G (2014) IL-22-secreting Th22 and IFN-γ-secreting Th17 cells in Behçet’s disease. Mod Rheumatol 24(5):802–807

    CAS  PubMed  Google Scholar 

  38. Blake SJ, Teng MWL (2014) Role of IL-17 and IL-22 in autoimmunity and cancer. Actas Dermosifiliogr 105:41–50

    PubMed  Google Scholar 

  39. Takeuchi M, Kastner DL, Remmers EF (2015) The immunogenetics of Behçet’s disease: a comprehensive review. J Autoimmun 64:137–148

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Uçar F, Sönmez M, Ermantaş N et al (2016) The associations of HLA-A, -B, DRB1 alleles and haplotypes in Turkish lymphoma patients. Gene 586(2):263–267

    PubMed  Google Scholar 

  41. **ao X, Liu L, Li W-J et al (2013) HLA-DRB1 polymorphisms and risk of cervical squamous epithelial cell carcinoma: a population study in China. Asian Pac J Cancer Prev 14(7):4427–4433

    PubMed  Google Scholar 

  42. Shuxian J, **aoyun C, Zhihui F et al (2014) Association of HLA-B*51:01 with papillary thyroid carcinoma in the Chinese Han population of the Shandong coastal areas. Thyroid 24(5):867–871

    PubMed  PubMed Central  Google Scholar 

  43. Baker GL, Kahl LE, Zee BC et al (1987) Malignancy following treatment of rheumatoid arthritis with cyclophosphamide: long-term case-control follow-up study. Am J Med 83(1):1–9

    CAS  PubMed  Google Scholar 

  44. Knight A, Askling J, Ekbom A (2002) Cancer incidence in a population-based cohort of patients with Wegener’s granulomatosis. Int J Cancer 100(1):82–85

    CAS  PubMed  Google Scholar 

  45. Buchbinder R, Barber M, Heuzenroeder L et al (2008) Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate. Arthritis Care Res 59(6):794–799

    CAS  Google Scholar 

  46. Bhattacharyya B, Panda D, Gupta S, Banerjee M (2008) Anti-mitotic activity of colchicine and the structural basis for its interaction with tubulin. Med Res Rev 28(1):155–183

    CAS  PubMed  Google Scholar 

  47. Lin Z-Y, Kuo C-H, Wu D-C, Chuang W-L (2016) Anticancer effects of clinically acceptable colchicine concentrations on human gastric cancer cell lines. Kaohsiung J Med Sci 32(2):68–73

    PubMed  Google Scholar 

  48. Lin Z-Y, Wu C-C, Chuang Y-H, Chuang W-L (2013) Anti-cancer mechanisms of clinically acceptable colchicine concentrations on hepatocellular carcinoma. Life Sci 93(8):323–328

    CAS  PubMed  Google Scholar 

  49. Kuo M-C, Chang S-J, Hsieh M-C (2015) Colchicine significantly reduces incident Cancer in gout male patients: a 12-year cohort study. Medicine 94(50):e1570–e1570

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Asmana NR (2014) Human interferon alpha-2b: a therapeutic protein for cancer treatment. Scientifica 2014:970315–970315

    Google Scholar 

  51. Zhu Z, Mei Z, Guo Y et al (2018) Reduced risk of inflammatory bowel disease-associated colorectal Neoplasia with use of Thiopurines: a systematic review and meta-analysis. J Crohn’s Colitis 12(5):546–558

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Hacettepe University Cancer Institute, 06100 Sıhhıye, Ankara, Turkey

    Deniz Can Guven, Burak Yasin Aktas, İbrahim Gullu & Omer Dizdar

  2. Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Ertugrul Cagri Bolek, Sedat Kiraz & Omer Karadag

  3. Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Sabri Engin Altintop & Burcu Celikten

Authors
  1. Deniz Can Guven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ertugrul Cagri Bolek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sabri Engin Altintop
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Burcu Celikten
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Burak Yasin Aktas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sedat Kiraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. İbrahim Gullu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Omer Karadag
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Omer Dizdar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deniz Can Guven.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approved by the Ethics Committee of Hacettepe University with an approval number GO 18/1043.

Consent to participate

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guven, D.C., Bolek, E.C., Altintop, S.E. et al. Cancer incidence in Behçet’s disease. Ir J Med Sci 189, 1209–1214 (2020). https://doi.org/10.1007/s11845-020-02244-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-020-02244-0

Keywords

Search

Navigation