ArticlePituitary2026
Cancer risk in a large acromegaly cohort: a standardized incidence ratio analysis.
Article in Pituitary, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate overall and site-specific cancer risk in a large Turkish acromegaly cohort and assess the contribution of surveillance bias.
methodsWe retrospectively analyzed 393 acromegaly patients followed at a single tertiary center (1980-2023). Standardized incidence ratios (SIRs) were calculated against Turkish national cancer rates. Sensitivity analyses included thyroid exclusion, graded landmarks (1, 2, 5 years), temporal restrictions, and reference rate variation (± 20%). Multivariable logistic regression assessed predictors of cancer, including cumulative IGF-1 exposure (time-weighted average, TWAvg×ULN).
resultsSixty-four patients (16.3%) developed cancer over a median follow-up of 9 years. The overall cancer SIR was 5.48 (95% CI: 4.15-7.10), driven by thyroid (46.25), renal/urinary (7.38), and breast cancer (3.75; all p < 0.001 except breast p = 0.006). The non-thyroid SIR remained significant at 2.76 (1.86-3.94, p < 0.001) and stable across graded landmarks (range 2.42-2.53; all p < 0.001) and other sensitivity analyses. TWAvg IGF-1 was higher in the cancer group (1.26 vs. 0.97 ×ULN; p = 0.002) and independently predicted cancer (OR: 1.80; 95% CI: 1.21-2.69; p = 0.004).
conclusionsIn this large single-center Turkish acromegaly cohort, the overall SIR (5.48) exceeded the pooled population-based estimate of 1.45. The non-thyroid SIR remained significant across all sensitivity analyses (range 2.22-3.45), indicating multi-site predisposition beyond surveillance bias. Cumulative IGF-1 exposure independently predicted cancer, supporting sustained hormonal excess as a driver of oncogenesis. These findings support systematic thyroid screening and heightened vigilance for non-thyroid malignancies in tertiary-managed acromegaly.
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