ECEESPE2025 Oral Communications Oral Communications 9: Endocrine Related Cancer (5 abstracts)
Acromegaly and cancer - a nationwide study in Sweden 1991-2018
Erika Tsatsaris 1 , Jonas Robért 2,3 , Katarina Berinder 4,5 , Lorenza Bonelli 6 , Pia Burman 7 , Per Dahlqvist 8 , Charlotte Höybye 4,5 , Oskar Ragnarsson 9,10,11 , Konstantina Vouzouneraki 8 , Anna-Karin Ækerman 12,13 , Bertil Ekman 2,3 & Britt Edén Engström 1
1Department of Medical Sciences, Endocrinology and Mineral Metabolism, Uppsala University Hospital, Uppsala University, Uppsala, Sweden, Uppsala University, Uppsala, Sweden; 2Departments of Endocrinology in Linköping and Norrköping, Linköping University, Linköping, Sweden; 3Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 4Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden; 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 6Department of Endocrinology, Skåne University Hospital Malmö, Malmö, Sweden; 7Department of Endocrinology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden; 8Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; 9Department of Endocrinology, Sahlgrenska University Hospital, Göteborg, Sweden; 10Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden; 11Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Göteborg, Sweden; 12Department of Internal Medicine, Örebro University Hospital, Örebro, Sweden; 13Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden
JOINT395
Introduction: Growth hormone (GH) excess and elevated levels of insulin-like growth factor-1 (IGF-1) in acromegaly are associated with cell proliferation and cancer promotion. We aimed to investigate the incidence of cancer and the cancer-related mortality in patients with acromegaly.
Methods: A register-based cohort study was performed in patients with acromegaly diagnosed 1991-2018, and identified in the Swedish Pituitary Register and in the National Patient Register. For each patient we included ten controls from the genereal population matched by sex, age and municipality of residence. Cancer diagnoses were obtained from the National Cancer Register. A Cox proportional hazard regression model adjusted for age, sex and comorbidity was used to estimate adjusted Hazard Ratio (aHR) and 95% CIs.
Results: We included 1035 patients with acromegaly (median age at diagnosis 52 years (Q1-Q3: 40-62.5), 49.5% female) and 10 261 control subjects. Median follow up time was 10.8 years (Q1-Q3: 5.2-17.5). Eighty percent underwent surgery and 13.5% radiation therapy. In the National Prescribed Drug Register from 2005 pharmacological treatment with Somatostatin analogs was reported in 41%, and GH receptor antagonist in 10% of the patients diagnosed from 2005. At 10 years follow-up 83% had biochemical control. Cancer was more common in the patients with acromegaly (aHR 1.33 (95% CI: 1.14-1.56), P <0.001). The highest aHR was found in the subgroups of colorectal cancer (aHR 1.73 (95% CI: 1.16-2.58), P=0.007) and lung cancer (aHR 1.92 (95% CI: 1.18-3.11), P=0.008). The aHR for these two cancer diagnoses was higher already from five years before acromegaly diagnosis until study end, which was also seen for breast cancer in women. Pituitary surgery, radiation therapy, hypopituitarism or biochemical control were not associated with cancer when they were included as covariates in a Cox regression model. The overall mortality rate was increased in the patients (aHR 1.19 (95% CI: 1.03-1.37), P=0.019), which was associated with cardiovascular disease (aHR 1.76 (95% CI: 1.22-2.53), P=0.002), but not with cancer, diabetes, hypertension or cerebrovascular disease. Biochemical control was associated with lower mortality (aHR 0.67 (95% CI: 0.49-0.91), P=0.011) compared to patients not biochemically controlled.
Conclusions: This matched nationwide study indicates an increased risk of cancer in patients with acromegaly even years before the diagnosis was established, with colorectal and lung cancer showing the highest increase in hazard ratios. Our findings underscore the importance for clinicians to be vigilant for early signs of cancer in patients with acromegaly.
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