Risk for cancer development in familial Mediterranean fever and associated predisposing factors: an ambidirectional cohort study from the international AIDA Network registries.

Petros P Sfikakis, Stefania Costi, Giacomo Emmi, Mohamad Khalil, Donato Rigante, Piero Portincasa, Bruno Frediani, Luca Cantarini, Claudia Fabiani, Stefano Gentileschi, Mahmoud Ghanema, Agostino Di Ciaula, Francesca Li Gobbi, Paolo Sfriso, Andrea Hinojosa-Azaola, Nour Jaber, Ahmed Hatem Laymouna, Maria Tarsia, Carla Gaggiano, Giuseppe Malizia, Antonio Luca Brucato, Riccardo Terribili, Giovanni Rosario Biasi, Neşe Çabuk Çelik, Maria Francesca Gicchino, Sara Silvaroli, Francesca Della Casa, Meri Romeo, Serena Patroniti, Roberta Loconte, Hulya Ercan Emreol, Seher Sener, Alberto Cauli, Ibrahim Vasi, Derya Yildirim, Henrique A Mayrink Giardini, Elena Verrecchia, Jessica Sbalchiero, Paola Parronchi, Jiram Torres-Ruiz, Piero Ruscitti, Daniela Opris-Belinski, Ezgi Deniz Batu, Seza Ozen, Ali Şahin, Patrizia Barone, Antonella Insalaco, Emma Aragona, José Hernández-Rodríguez, Amato De Paulis, Alessandro Conforti, Moustafa Ali Saad, Riza Can Kardas, Andreas Recke, Andrea Affronti, Alberto Balistreri, Ewa Wiesik-Szewczyk, Karina Jahnz-Różyk, Abdurrahman Tufan, Jurgen Sota, Gaafar Ragab, Valeria Caggiano, Antonio Vitale, Eduardo Martín-Nares, Giuseppe Lopalco, Samar Tharwat, Marco Cattalini, Hamit Kucuk, Benson Ogunjimi, Francesco La Torre, Maria Cristina Maggio, Anastasios Karamanakos, Alma Nunzia Olivieri, Giovanni Conti, Emanuela Del Giudice, Ilaria Mormile

Journal: Frontiers in immunology 2024;15():1397890

PMID: 38799474

Abstract

OBJECTIVE

Inflammation has been associated with an increased risk for cancer development, while innate immune system activation could counteract the risk for malignancies. Familial Mediterranean fever (FMF) is a severe systemic inflammatory condition and also represents the archetype of innate immunity deregulation. Therefore, the aim of this study is to investigate the risk for cancer development in FMF.

METHODS

The risk ratio (RR) for malignancies was separately compared between FMF patients and fibromyalgia subjects, Still's disease patients and Behçet's disease patients. Clinical variables associated with cancer development in FMF patients were searched through binary logistic regression.

RESULTS

580 FMF patients and 102 fibromyalgia subjects, 1012 Behçet's disease patients and 497 Still's disease patients were enrolled. The RR for the occurrence of malignant neoplasms was 0.26 (95% Confidence Interval [CI.] 0.10-0.73, p=0.006) in patients with FMF compared to fibromyalgia subjects; the RR for the occurrence of malignant cancer was 0.51 (95% CI. 0.23-1.16, =0.10) in FMF compared to Still's disease and 0.60 (95% CI. 0.29-1.28, =0.18) in FMF compared to Behçet's disease. At logistic regression, the risk of occurrence of malignant neoplasms in FMF patients was associated with the age at disease onset (β1 = 0.039, 95% CI. 0.001-0.071, =0.02), the age at the diagnosis (β1 = 0.048, 95% CI. 0.039-0.085, =0.006), the age at the enrolment (β1 = 0.05, 95% CI. 0.007-0.068, =0.01), the number of attacks per year (β1 = 0.011, 95% CI. 0.001- 0.019, =0.008), the use of biotechnological agents (β1 = 1.77, 95% CI. 0.43-3.19, =0.009), the use of anti-IL-1 agents (β1 = 2.089, 95% CI. 0.7-3.5, =0.002).

CONCLUSIONS

The risk for cancer is reduced in Caucasic FMF patients; however, when malignant neoplasms occur, this is more frequent in FMF cases suffering from a severe disease phenotype and presenting a colchicine-resistant disease.

Copyright © 2024 Vitale, Caggiano, Tufan, Ragab, Batu, Portincasa, Aragona, Sota, Conti, De Paulis, Rigante, Olivieri, Şahin, La Torre, Lopalco, Cattalini, Maggio, Insalaco, Sfikakis, Verrecchia, Yildirim, Kucuk, Kardas, Laymouna, Ghanema, Saad, Sener, Ercan Emreol, Ozen, Jaber, Khalil, Di Ciaula, Gaggiano, Malizia, Affronti, Patroniti, Romeo, Sbalchiero, Della Casa, Mormile, Silvaroli, Gicchino, Çelik, Tarsia, Karamanakos, Hernández-Rodríguez, Parronchi, Opris-Belinski, Barone, Recke, Costi, Sfriso, Giardini, Gentileschi, Wiesik-Szewczyk, Vasi, Loconte, Jahnz-Różyk, Martín-Nares, Torres-Ruiz, Cauli, Conforti, Emmi, Li Gobbi, Biasi, Terribili, Ruscitti, Del Giudice, Tharwat, Brucato, Ogunjimi, Hinojosa-Azaola, Balistreri, Fabiani, Frediani and Cantarini.

Address: Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.; Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy.; Gazi University Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Türkiye.; Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt.; Faculty of Medicine, Newgiza University, 6th of October City, Giza, Egypt.; Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Türkiye.; Clinica Medica "A. Murri", Division of Internal Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J), University of Bari Aldo Moro, Bari, Italy.; Division of Gastroenterology, Ospedali Riuniti Villa Sofia-Vincenzo Cervello, Palermo, Italy.; Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU), "G. Martino", Messina, Italy.; Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy.; Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy.; Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Rare Diseases and Periodic Fevers Research Center, Università Cattolica del Sacro Cuore, Rome, Italy.; Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.; Division of Rheumatology, Department of Internal Medicine, Sivas Cumhuriyet University Medical Faculty, Sivas, Türkiye.; Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy.; Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J) Policlinic Hospital, University of Bari, Bari, Italy.; Pediatrics Clinic, University of Brescia and Spedali Civili of Brescia, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Brescia, Italy.; University Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy.; Division of Rheumatology, Ospedale Pediatrico Bambino Gesù, IRCCS [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Rome, Italy.; Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Athens, Greece.; Rare Diseases and Periodic Fevers Research Center, Università Cattolica del Sacro Cuore, Rome, Italy.; Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.; Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Giza, Egypt.; Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy.; Department of Pediatric Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.; Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy.; Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy.; Department of Rheumatology, "Evangelismos" General Hospital, Athens, Greece.; Department of Autoimmune Diseases, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic of Barcelona [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], University of Barcelona, Barcelona, Spain.; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.; Rheumatology and Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.; Pediatric Rheumatology Unit, Department of integrated Maternal-Child and Reproduction Activity AOU "Policlinico-San Marco", Catania, Italy.; Department of Dermatology, Allergology and Venerology, University Hospital Schleswig-Holstein, Lübeck, Germany.; Autoinflammatory and Autoimmune Diseases (RITA) Center, European Reference Network (ERN) for Rare Immunodeficiency, Lübeck, Germany.; Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.; Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy.; Rheumatology Division, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.; Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, National Research Institute, Warsaw, Poland.; Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.; Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy.; Ospedale San Paolo di Civitavecchia, U.O. Medicina Generale, ASL Roma 4, Civitavecchia, Rome, Italy.; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy, and Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy.; Centre for Inflammatory Diseases, Department of Medicine, Monash Medical Centre, Monash University, Clayton, VIC, Australia.; Rheumatology Unit, Hospital S. Giovanni di Dio, Azienda USL-Toscana Centro, Florence, Italy.; Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.; Pediatric and Neonatology Unit, Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Latina, Italy.; Rheumatology and Immunology Unit, Internal Medicine Department, Mansoura University, Mansoura, Egypt.; Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.; Department of Biomedical and Clinical Sciences, Fatebenefratelli Hospital, Università di Milano, Milan, Italy.; Antwerp Unit for Data Analysis and Computation in Immunology and Sequencing, University of Antwerp, Antwerp, Belgium.; Antwerp Center for Translational Immunology and Virology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.; Department of Pediatrics, Antwerp University Hospital, Antwerp, Belgium.; Center for Health Economics Research and Modeling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.; Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy.; Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy.; Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
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