4.7 Article

Paraneoplastic neurological syndromes associated with renal or bladder cancer: case series and PRISMA-IPD systematic review

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JOURNAL OF NEUROLOGY
卷 270, 期 1, 页码 283-299

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SPRINGER HEIDELBERG
DOI: 10.1007/s00415-022-11356-9

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Paraneoplastic neurological syndromes; Renal cell cancer; Bladder cancer; Cerebellar ataxia; Neural antibodies

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The link between renal cell and bladder cancer and paraneoplastic neurological syndromes (PNS) is rare and uncertain. This study clinically evaluated these associations and found that bladder cancer patients had higher detection rates of high-risk antibodies and higher certainty of PNS diagnosis.
Background The link between paraneoplastic neurological syndromes (PNS) and renal cell and bladder cancer (RCC/BC) is rare and uncertain. Our aim was to clinically evaluate, in light of the updated PNS criteria, these uncommon associations. Methods Retrospective nationwide cohort chart review study and systematic review of the literature. Results After excluding 5 patients due to the diagnosis of another co-occurrent malignancy, 10/18 patients with RCC and 8/18 patients with BC were identified. A total of 31 cases were previously published, yielding an overall series of 27/49 RCC and 22/49 BC patients. There was a predominance of cerebellar syndromes in both cancers (10/27, 37% for RCC; 9/22, 41% for BC), followed by encephalitis in 9/27 (33%) patients with RCC and encephalomyelitis/sensory neuronopathy in 5/22 (23%) patients with BC. The detection of high-risk Abs was more frequent among BC patients (16/19, 84% vs. 3/13, 23% in RCC, p = 0.0009), Ri antibodies being the most frequent thereof. After applying the updated PNS criteria, patients with BC met highest degrees (possible, probable, and definite) of certainty for PNS diagnosis (20/22, 91% vs. 16/27, 59% in RCC, p = 0.021). Conclusion A second neoplasm should always be ruled out before establishing the diagnosis of PNS in patients with RCC or BC. However, while this association remains dubious for most patients with RCC, a casual role is more probable in patients with BC and high-risk antibodies presenting with cerebellar ataxia, brainstem encephalitis or encephalomyelitis/sensory neuronopathy.

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