Thomas E, Brewster D H, Black R J, Macfarlane G J
Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, The Medical School, University of Manchester, United Kingdom.
Int J Cancer. 2000 Nov 1;88(3):497-502.
Previous studies have described an increased risk of malignancy in subjects diagnosed with rheumatic conditions, most notably rheumatoid arthritis (RA). Our aim was to quantify and compare risks for site-specific malignancy among hospitalized patients with RA, osteoarthritis (OA) and other rheumatic conditions in a nationwide, population-based cohort. Subjects were identified from Scottish hospital in-patient records from 1981 to 1996 and followed up by computer linkage of the Scottish Cancer Registry and the national registry of deaths. Expected cancer incidence was calculated from national cancer rates and related to the observed incidence by the standardized incidence ratio (SIR). Among RA patients, there was an increased risk for hematopoietic [males SIR= 2.13, 95% confidence interval (CI) 1.7-2.7; females SIR = 1.76, 95% CI 1.5-2.1], lung (males SIR = 1.32, 95% CI 1.2-1.5; females SIR = 1.44, 95% CI 1.3-1.6) and prostate (SIR = 1.26, 95% CI 1.0-1.6) cancers. Reduced risk were seen for colorectal cancer (males SIR = 0.87, 95% CI 0.7-1.1; females SIR = 0.71, 95% CI 0.6-0.9) and, among females, stomach cancer (SIR = 0.70, 95% CI 0.5-1.0). The excess risk for hematopoietic cancer and the reduced risk for colorectal and stomach cancers were sustained over 10 years of follow-up. An overall decreased risk of cancer was observed for patients with OA; the greatest reductions were observed for colorectal (males SIR = 0.88, 95% CI 0.8-1.0; females SIR = 0.84, 95% CI 0.8-0.9), stomach (males SIR = 0.79, 95% CI 0.7-0.9; females SIR = 0.66, 95% CI 0.6-0.8) and lung (males SIR = 0.72, 95% CI 0.7-0.8; females SIR = 0.84, 95% CI 0.8-0.9) malignancies, with decreased risks generally still evident at 10 years of follow-up. Our results support several previous findings regarding the incidence of hematopoietic and colorectal malignancies in RA patients. In addition, we have shown a large decrease in stomach cancer among patients with OA and females with RA that warrants further investigation since it may provide clues to possible prevention strategies. To further our knowledge about the underlying mechanisms of altered risk in cancer patients with rheumatic conditions, population studies requiring primary data collection are required.
以往的研究表明，被诊断患有风湿性疾病的患者，尤其是类风湿关节炎（RA）患者，患恶性肿瘤的风险增加。我们的目的是在一个全国性的、基于人群的队列中，对住院的RA、骨关节炎（OA）和其他风湿性疾病患者特定部位恶性肿瘤的风险进行量化和比较。研究对象来自1981年至1996年苏格兰医院的住院记录，并通过与苏格兰癌症登记处和国家死亡登记处的计算机链接进行随访。根据全国癌症发病率计算预期癌症发病率，并通过标准化发病率比（SIR）将其与观察到的发病率相关联。在RA患者中，造血系统癌症（男性SIR = 2.13，95%置信区间[CI] 1.7 - 2.7；女性SIR = 1.76，95% CI 1.5 - 2.1）、肺癌（男性SIR = 1.32，95% CI 1.2 - 1.5；女性SIR = 1.44，95% CI 1.3 - 1.6）和前列腺癌（SIR = 1.26，95% CI 1.0 - 1.6）的风险增加。结直肠癌（男性SIR = 0.87，95% CI 0.7 - 1.1；女性SIR = 0.71，95% CI 0.6 - 0.9）以及女性胃癌（SIR = 0.70，95% CI 0.5 - 1.0）的风险降低。造血系统癌症的额外风险以及结直肠癌和胃癌的风险降低在10年的随访中持续存在。OA患者总体上患癌风险降低；结直肠癌（男性SIR = 0.88，95% CI 0.8 - 1.0；女性SIR = 0.84，95% CI 0.8 - 0.9）、胃癌（男性SIR = 0.79，95% CI 0.7 - 0.9；女性SIR = 0.66，95% CI 0.6 - 0.8）和肺癌（男性SIR = 0.72，95% CI 0.7 - 0.8；女性SIR = 0.84，95% CI 0.8 - 0.9）的恶性肿瘤风险降低最为明显，在10年随访时风险降低通常仍然显著。我们的结果支持了之前关于RA患者造血系统和结直肠恶性肿瘤发病率的几项研究结果。此外，我们还发现OA患者和女性RA患者的胃癌大幅减少，这值得进一步研究，因为它可能为潜在的预防策略提供线索。为了进一步了解风湿性疾病癌症患者风险改变的潜在机制，需要进行需要收集原始数据的人群研究。
