Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide
Objective: To assess and characterise the risk of bladder cancer, and its relation to cyclophosphamide, in patients with Wegener’s granulomatosis. Methods: In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener’s granulomatosis, 1969–95, was identified....
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| Veröffentlicht in: | Annals of the rheumatic diseases 2004-10, Vol.63 (10), p.1307-1311 |
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| creator | Knight, A Askling, J Granath, F Sparen, P Ekbom, A |
| description | Objective: To assess and characterise the risk of bladder cancer, and its relation to cyclophosphamide, in patients with Wegener’s granulomatosis. Methods: In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener’s granulomatosis, 1969–95, was identified. Through linkage with the Swedish Cancer Register, all subjects in this cohort diagnosed with bladder cancer were identified. Nested within the cohort, a matched case-control study was performed to estimate the association between cyclophosphamide and bladder cancer using odds ratios (ORs) as relative risk. In the cohort the cumulative risk of bladder cancer after Wegener’s granulomatosis, and the relative prevalence of a history of bladder cancer at the time of diagnosis of Wegener’s granulomatosis, were also estimated. Results: The median cumulative doses of cyclophosphamide among cases (n = 11) and controls (n = 25) were 113 g and 25 g, respectively. The risk of bladder cancer doubled for every 10 g increment in cyclophosphamide (OR = 2.0, 95% confidence interval (CI) 0.8 to 4.9). Treatment duration longer than 1 year was associated with an eightfold increased risk (OR = 7.7, 95% CI 0.9 to 69). The absolute risk for bladder cancer in the cohort reached 10% 16 years after diagnosis of Wegener’s granulomatosis, and a history of bladder cancer was (non-significantly) twice as common as expected at the time of diagnosis of Wegener’s granulomatosis. Conclusion: The results indicate a dose-response relationship between cyclophosphamide and the risk of bladder cancer, high cumulative risks in the entire cohort, and also the possibility of risk factors operating even before Wegener’s granulomatosis. |
| doi_str_mv | 10.1136/ard.2003.019125 |
| format | Article |
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Methods: In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener’s granulomatosis, 1969–95, was identified. Through linkage with the Swedish Cancer Register, all subjects in this cohort diagnosed with bladder cancer were identified. Nested within the cohort, a matched case-control study was performed to estimate the association between cyclophosphamide and bladder cancer using odds ratios (ORs) as relative risk. In the cohort the cumulative risk of bladder cancer after Wegener’s granulomatosis, and the relative prevalence of a history of bladder cancer at the time of diagnosis of Wegener’s granulomatosis, were also estimated. Results: The median cumulative doses of cyclophosphamide among cases (n = 11) and controls (n = 25) were 113 g and 25 g, respectively. The risk of bladder cancer doubled for every 10 g increment in cyclophosphamide (OR = 2.0, 95% confidence interval (CI) 0.8 to 4.9). Treatment duration longer than 1 year was associated with an eightfold increased risk (OR = 7.7, 95% CI 0.9 to 69). The absolute risk for bladder cancer in the cohort reached 10% 16 years after diagnosis of Wegener’s granulomatosis, and a history of bladder cancer was (non-significantly) twice as common as expected at the time of diagnosis of Wegener’s granulomatosis. Conclusion: The results indicate a dose-response relationship between cyclophosphamide and the risk of bladder cancer, high cumulative risks in the entire cohort, and also the possibility of risk factors operating even before Wegener’s granulomatosis.</description><identifier>ISSN: 0003-4967</identifier><identifier>ISSN: 1468-2060</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/ard.2003.019125</identifier><identifier>PMID: 15130900</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and European League Against Rheumatism</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Bladder cancer ; Case-Control Studies ; cyclophosphamide ; Cyclophosphamide - adverse effects ; Cyclophosphamide - therapeutic use ; Diseases of the osteoarticular system ; Dose-Response Relationship, Drug ; Extended Report ; Female ; Granulomatosis with Polyangiitis - complications ; Granulomatosis with Polyangiitis - drug therapy ; haemorrhagic cystitis ; Humans ; Immunosuppressive Agents - adverse effects ; Immunosuppressive Agents - therapeutic use ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; Risk Assessment ; Risk Factors ; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis ; Tumors of the urinary system ; Urinary Bladder Neoplasms - chemically induced ; Urinary Bladder Neoplasms - etiology ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland ; Wegener’s granulomatosis</subject><ispartof>Annals of the rheumatic diseases, 2004-10, Vol.63 (10), p.1307-1311</ispartof><rights>Copyright 2004 by Annals of the Rheumatic Diseases</rights><rights>2004 INIST-CNRS</rights><rights>Copyright: 2004 Copyright 2004 by Annals of the Rheumatic Diseases</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b594t-308cd98361be2ac041c0fcee6b07502e2b71154ccb7be1278cf8d196543beac93</citedby><cites>FETCH-LOGICAL-b594t-308cd98361be2ac041c0fcee6b07502e2b71154ccb7be1278cf8d196543beac93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754772/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754772/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,551,724,777,781,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16135263$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15130900$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-95896$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:1937274$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Knight, A</creatorcontrib><creatorcontrib>Askling, J</creatorcontrib><creatorcontrib>Granath, F</creatorcontrib><creatorcontrib>Sparen, P</creatorcontrib><creatorcontrib>Ekbom, A</creatorcontrib><title>Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide</title><title>Annals of the rheumatic diseases</title><addtitle>Ann Rheum Dis</addtitle><description>Objective: To assess and characterise the risk of bladder cancer, and its relation to cyclophosphamide, in patients with Wegener’s granulomatosis. Methods: In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener’s granulomatosis, 1969–95, was identified. Through linkage with the Swedish Cancer Register, all subjects in this cohort diagnosed with bladder cancer were identified. Nested within the cohort, a matched case-control study was performed to estimate the association between cyclophosphamide and bladder cancer using odds ratios (ORs) as relative risk. In the cohort the cumulative risk of bladder cancer after Wegener’s granulomatosis, and the relative prevalence of a history of bladder cancer at the time of diagnosis of Wegener’s granulomatosis, were also estimated. Results: The median cumulative doses of cyclophosphamide among cases (n = 11) and controls (n = 25) were 113 g and 25 g, respectively. The risk of bladder cancer doubled for every 10 g increment in cyclophosphamide (OR = 2.0, 95% confidence interval (CI) 0.8 to 4.9). Treatment duration longer than 1 year was associated with an eightfold increased risk (OR = 7.7, 95% CI 0.9 to 69). The absolute risk for bladder cancer in the cohort reached 10% 16 years after diagnosis of Wegener’s granulomatosis, and a history of bladder cancer was (non-significantly) twice as common as expected at the time of diagnosis of Wegener’s granulomatosis. Conclusion: The results indicate a dose-response relationship between cyclophosphamide and the risk of bladder cancer, high cumulative risks in the entire cohort, and also the possibility of risk factors operating even before Wegener’s granulomatosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Bladder cancer</subject><subject>Case-Control Studies</subject><subject>cyclophosphamide</subject><subject>Cyclophosphamide - adverse effects</subject><subject>Cyclophosphamide - therapeutic use</subject><subject>Diseases of the osteoarticular system</subject><subject>Dose-Response Relationship, Drug</subject><subject>Extended Report</subject><subject>Female</subject><subject>Granulomatosis with Polyangiitis - complications</subject><subject>Granulomatosis with Polyangiitis - drug therapy</subject><subject>haemorrhagic cystitis</subject><subject>Humans</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</subject><subject>Tumors of the urinary system</subject><subject>Urinary Bladder Neoplasms - chemically induced</subject><subject>Urinary Bladder Neoplasms - etiology</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><subject>Wegener’s granulomatosis</subject><issn>0003-4967</issn><issn>1468-2060</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>D8T</sourceid><recordid>eNqFkU1v1DAQhi0EokvhzA1FQlxA2dpx_NUDUrXlU6siJFouSJbjOLveTezFToDe-Bv8PX4JXiXq0gPiNLbnmXfG8wLwGME5QpieqFDPCwjxHCKBCnIHzFBJeV5ACu-CGUyZvBSUHYEHMW7SFXLE74MjRBCGAsIZ-HIZrFPhOqtaVdcmZFo5nYJ12WezMs6E3z9_xWwVlBta36neRxtPs2DjNmbK1Vkwreqtd1nvM32tW79b-7hbq87W5iG416g2mkdTPAaXr199WrzNlx_evFucLfOKiLLPMeS6FhxTVJlCaVgiDRttDK0gI7AwRcUQIqXWFasMKhjXDa-RoKTElVFa4GOQj7rxu9kNldwF26U_Sa-snJ626WQk4YTCMvEv_smf26sz6cNKDoMUhAua6JcjndDO1Nq4Pqj2VtHtjLNrufLfJGKkZKxIAk8ngeC_Dib2cuOH4NJGEsIYLwkVJFEnI6WDjzGY5qYDgnJvtkxmy73ZcjQ7VTz5e7ADP7mbgGcToKJWbZNM1DYeOIowKSg-7M_G3vy4yauwlZRhRuTF1UIuGUXnFx_fy_3-no981W3-O-UfP5fSAQ</recordid><startdate>20041001</startdate><enddate>20041001</enddate><creator>Knight, A</creator><creator>Askling, J</creator><creator>Granath, F</creator><creator>Sparen, P</creator><creator>Ekbom, A</creator><general>BMJ Publishing Group Ltd and European League Against Rheumatism</general><general>BMJ</general><general>Elsevier Limited</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>DF2</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20041001</creationdate><title>Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide</title><author>Knight, A ; Askling, J ; Granath, F ; Sparen, P ; Ekbom, A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b594t-308cd98361be2ac041c0fcee6b07502e2b71154ccb7be1278cf8d196543beac93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Bladder cancer</topic><topic>Case-Control Studies</topic><topic>cyclophosphamide</topic><topic>Cyclophosphamide - adverse effects</topic><topic>Cyclophosphamide - therapeutic use</topic><topic>Diseases of the osteoarticular system</topic><topic>Dose-Response Relationship, Drug</topic><topic>Extended Report</topic><topic>Female</topic><topic>Granulomatosis with Polyangiitis - complications</topic><topic>Granulomatosis with Polyangiitis - drug therapy</topic><topic>haemorrhagic cystitis</topic><topic>Humans</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis</topic><topic>Tumors of the urinary system</topic><topic>Urinary Bladder Neoplasms - chemically induced</topic><topic>Urinary Bladder Neoplasms - etiology</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><topic>Wegener’s granulomatosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Knight, A</creatorcontrib><creatorcontrib>Askling, J</creatorcontrib><creatorcontrib>Granath, F</creatorcontrib><creatorcontrib>Sparen, P</creatorcontrib><creatorcontrib>Ekbom, A</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Uppsala universitet</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Knight, A</au><au>Askling, J</au><au>Granath, F</au><au>Sparen, P</au><au>Ekbom, A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide</atitle><jtitle>Annals of the rheumatic diseases</jtitle><addtitle>Ann Rheum Dis</addtitle><date>2004-10-01</date><risdate>2004</risdate><volume>63</volume><issue>10</issue><spage>1307</spage><epage>1311</epage><pages>1307-1311</pages><issn>0003-4967</issn><issn>1468-2060</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>Objective: To assess and characterise the risk of bladder cancer, and its relation to cyclophosphamide, in patients with Wegener’s granulomatosis. Methods: In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener’s granulomatosis, 1969–95, was identified. Through linkage with the Swedish Cancer Register, all subjects in this cohort diagnosed with bladder cancer were identified. Nested within the cohort, a matched case-control study was performed to estimate the association between cyclophosphamide and bladder cancer using odds ratios (ORs) as relative risk. In the cohort the cumulative risk of bladder cancer after Wegener’s granulomatosis, and the relative prevalence of a history of bladder cancer at the time of diagnosis of Wegener’s granulomatosis, were also estimated. Results: The median cumulative doses of cyclophosphamide among cases (n = 11) and controls (n = 25) were 113 g and 25 g, respectively. The risk of bladder cancer doubled for every 10 g increment in cyclophosphamide (OR = 2.0, 95% confidence interval (CI) 0.8 to 4.9). Treatment duration longer than 1 year was associated with an eightfold increased risk (OR = 7.7, 95% CI 0.9 to 69). The absolute risk for bladder cancer in the cohort reached 10% 16 years after diagnosis of Wegener’s granulomatosis, and a history of bladder cancer was (non-significantly) twice as common as expected at the time of diagnosis of Wegener’s granulomatosis. Conclusion: The results indicate a dose-response relationship between cyclophosphamide and the risk of bladder cancer, high cumulative risks in the entire cohort, and also the possibility of risk factors operating even before Wegener’s granulomatosis.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and European League Against Rheumatism</pub><pmid>15130900</pmid><doi>10.1136/ard.2003.019125</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Bladder cancer Case-Control Studies cyclophosphamide Cyclophosphamide - adverse effects Cyclophosphamide - therapeutic use Diseases of the osteoarticular system Dose-Response Relationship, Drug Extended Report Female Granulomatosis with Polyangiitis - complications Granulomatosis with Polyangiitis - drug therapy haemorrhagic cystitis Humans Immunosuppressive Agents - adverse effects Immunosuppressive Agents - therapeutic use Male Medical sciences Middle Aged Nephrology. Urinary tract diseases Risk Assessment Risk Factors Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Tumors of the urinary system Urinary Bladder Neoplasms - chemically induced Urinary Bladder Neoplasms - etiology Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland Wegener’s granulomatosis |
| title | Urinary bladder cancer in Wegener’s granulomatosis: risks and relation to cyclophosphamide |
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