King's College London

Research portal

Association of serum immunoglobulin levels with solid cancer: a systematic review and meta-analysis

Research output: Contribution to journalReview article

Ioannis Peppas, Gincy George, Sam Sollie, Debra H Josephs, Niklas Hammar, Goran Walldius, Sophia N Karagiannis, Mieke Van Hemelrijck

Original languageEnglish
Pages (from-to)527-538
Number of pages12
JournalCancer Epidemiology, Biomarkers & Prevention
Issue number3
Early online date8 Jan 2020
Publication statusPublished - 1 Mar 2020

Bibliographical note

Copyright ©2020, American Association for Cancer Research.

King's Authors


BACKGROUND: The nature of humoral immunity in carcinogenesis remains poorly understood. In this systematic review and meta-analysis, we aimed to evaluate the association of serum immunoglobulin classes with solid cancer and test our hypothesis that the immune escape of tumors is accompanied by dysregulated systemic immunoglobulin class-switching. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched the Cochrane Library, Embase, and MEDLINE/PubMed databases for observational studies investigating the association between serum immunoglobulins (IgA, IgG, and IgM) and histologically confirmed diagnosis of solid cancer in adults. We selected case-control studies, including more than 20 cases, and those explicitly stating that no form of anticancer treatment was administered prior to immunoglobulin measurement. No eligible cohort studies were identified. The primary summary measure was the standardized mean difference (SMD) with 95% confidence intervals (CI) calculated using a random effects model. RESULTS: Pooling 11 eligible studies comparing serum IgA levels in 1,351 patients and 560 control subjects revealed a statistically significant SMD (1.50; 95% CI, 0.96-2.04). Nonsignificant SMDs were observed for the 14 selected studies investigating serum IgG [SMD, -0.02 (95% CI, -0.22 to 0.18)] and for the 10 studies reporting serum IgM [SMD, 0.11 (95% CI, -0.10 to 0.32)]. Substantial heterogeneity between studies was observed despite sensitivity analysis by immunoglobulin measurement method, control matching, type of cancer, stage of disease, and sequential study exclusion. CONCLUSIONS: Serum immunoglobulin levels in patients diagnosed with solid cancer might be skewed toward class-switching to IgA, possibly reflecting Th2-polarized immunity. IMPACT: Further combinatorial analyses of serum immunoglobulin isotypes alongside other immune parameters in databases and observational studies are warranted.

View graph of relations

© 2018 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454