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108 IS MULTIPLE SCLEROSIS A PARANEOPLASTIC DISORDER?
  1. A. Sumrall1,
  2. J. Oliver1,
  3. E. Rose1
  1. 1G.V. Montgomery Veterans' Affairs Medical Center, Jackson, MS.

Abstract

Several articles in the literature have reported concomitant demyelination with cancer. There have been four cases of CNS lymphoma and three cases of seminoma associated with central demyelination. Hairy cell leukemia and breast cancer have also been reported in patients with multiple sclerosis (MS). A paraneoplastic etiology for these cases of demyelination has been suggested by several authors, with proposed theories of viral-mediated, autoimmune, and lymphocytic infiltrates that transform into malignancy. A retrospective chart review of adult patients with MS from the VA Medical Center in Jackson, MS, during January 1, 1999, to August 26, 2005, was conducted. For inclusion, the diagnosis of MS was made by MRI of the brain and/or cerebrospinal fluid studies. The records were further examined to see if patients had a diagnosis of cancer. In patients who had cancer and MS, a family history was obtained. The patients were further analyzed by age, race, and gender. A retrospective chart review of 581 adult patients seen in a neurology clinic during the same time frame was conducted to serve as the control group. The records were examined to see if patients had a diagnosis of MS and/or cancer. The patients were further analyzed based on age, race, and gender. Fifty-eight patients with MS met the inclusion criteria (17 females, 41 males). Four of those patients were found to have cancer. In each case, the diagnosis of MS preceded the cancer diagnosis by at least 5 years. Of 581 adult patients in the control group, 8 had MS and 79 had cancer. No patients had concomitant MS and cancer. The group was composed of 35 females and 546 males. There was no increased risk of developing cancer in patients with MS. The p value was .1478; the power was 5%. The odds ratio was 0.47 with a 95% confidence interval of 0.1659 to 1.3357. MS does not appear to be a paraneoplastic process in our patient population. Patients in our hospital are no more likely than the general population to have cancer. Based on the odds ratio, patients with MS are actually twice as likely to not have cancer. Unfortunately, the power of this study is low due to the small number of patients with MS. Even with a high p value, the evidence suggests that the findings of this study are significant. This is the first study of patients in the United States with MS to assess for an association with cancer. It is also the first evidence-based study in the United States to show a decreased rate of cancer in patients with MS.

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