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

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Abstract

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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Acknowledgements

The authors thank NeuroBioTec Hospices Civils de Lyon BRC (France, AC-2013-1867, NFS96-900) for banking sera and CSF samples. They thank Hélène Boyer for help in manuscript preparation (Service de relecture scientifique, Hospices Civils de Lyon). The authors express their grateful thanks to Drs. Laurys Boudin (HIA Sainte-Anne), JP Fulgencio (AP-HP Tenon), Benoit Lionnet (CHRU Tours), Marie Goussef (CH Bretagne Atlantique), Alexandre Kreisler (CHU Lille), Charlotte Davenas (CHU Lyon), Clotilde Verlut (CHU Besançon), Stéphane Berroir (CH Alpes Léman), Bernard Simorre (CH Beziers), Celine Renkes and Amer Khatib (CH Troyes) who sent them clinical data and biological samples for the study.

Funding

This work is supported by a public grant overseen by the Agence nationale de la recherche (ANR, French research agency) as part of the “Investissements d’Avenir” program (ANR-18-RHUS-0012). This study was performed within the framework of the LABEX CORTEX (ANR-11-LABX-0042) of the Université Claude Bernard Lyon 1, within the program "Investissements d'Avenir" (ANR-11-LABX-0042) operated by the ANR.

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Authors and Affiliations

  1. French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France

    Macarena Villagrán-García, Sergio Muñiz-Castrillo, Nicolás Lundahl Ciano-Petersen, Antonio Farina, Marine Villard, Véronique Rogemond, Bastien Joubert & Jérôme Honnorat

  2. MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard, Lyon 1, Lyon, France

    Macarena Villagrán-García, Sergio Muñiz-Castrillo, Nicolás Lundahl Ciano-Petersen, Antonio Farina, Bastien Joubert & Jérôme Honnorat

  3. Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain

    Nicolás Lundahl Ciano-Petersen

  4. Red Andaluza de Investigación Clínica y Traslacional en Neurología (NeuroRECA), Málaga, Spain

    Nicolás Lundahl Ciano-Petersen

  5. Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy

    Alberto Vogrig

  6. Neurology 2 Department Mazarin, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France

    Dimitri Psimaras & Agusti Alentorn

  7. Sorbonne Université, Inserm, CNRS, Paris Brain Institute, Institut du Cerveau et de la Moelle Épinière, ICM, 75013, Paris, France

    Dimitri Psimaras & Agusti Alentorn

  8. Immunology Department, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France

    David Gonçalves & Nicole Fabien

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  1. Macarena Villagrán-García
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Correspondence to Jérôme Honnorat.

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Disclosure

Macarena Villagrán-García received a fellowship grant from the Spanish Society of Neurology.

Conflicts of interest

The authors declare no conflict of interest.

Ethics approval

All patients recruited in the French Reference Centre on Paraneoplastic Neurologic Syndromes and Autoimmune Encephalitis (Lyon, France) provided written informed consent for the storage and use of their serum and cerebrospinal fluid (CSF) samples and clinical information for research purposes. The Institutional Review Board of the Université Claude Bernard Lyon 1 and Hospices Civils de Lyon approved the study (GenePNS, 19-62, NCT-03963700). The study was performed in accordance with the ethical standards framed by the Declaration of Helsinki and its later amendments.

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415_2022_11356_MOESM1_ESM.pdf

Supplementary Fig. 1 Preferred Reporting Items for Individual Patient Data Systematic Reviews (PRISMA-IPD) Flowchart. Abbreviations: BC: bladder cancer; ICI: immune checkpoint inhibitors; IPD: individual personal data; RCC: renal cell cancer. *n=1 article contains information of two patients. (PDF 512 KB)

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Villagrán-García, M., Muñiz-Castrillo, S., Ciano-Petersen, N.L. et al. Paraneoplastic neurological syndromes associated with renal or bladder cancer: case series and PRISMA-IPD systematic review. J Neurol 270, 283–299 (2023). https://doi.org/10.1007/s00415-022-11356-9

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