Fryzek Jon P, Ye Weimin, Signorello Lisa B, Lipworth Loren, Blot William J, McLaughlin Joseph K, Nyren Olof
International Epidemiology Institute, Rockville, Maryland 20850, USA.
Cancer. 2002 Jun 1;94(11):3057-62. doi: 10.1002/cncr.10580.
As knee implants become more common, it is important to study their potential health risks. We investigated cancer occurrence in a nationwide population-based cohort of 30,011 patients who underwent knee replacement surgery in Sweden from 1980 to 1994.
Patients were followed from 1 year after the date of their surgery through December 31, 1995, accruing 122,616 person-years of observation. The average follow-up time was 4.3 years, with 2365 patients followed for 10 years or more.
Overall cancer incidence was not elevated compared with the general population of Sweden (standardized incidence ratio [SIR] = 1.03; 95% confidence interval [CI] = 0.98-1.08). A reduced rate for all respiratory cancers (SIR = 0.73; 95% CI = 0.59-0.91) and for lung cancer (SIR = 0.73; 95% CI = 0.58-0.91) was found among both men and women. Elevated rates were found for prostate (SIR = 1.20; 95% CI = 1.06-1.34) and bone cancer (SIR = 6.00; 95% CI = 1.24-17.52) in men. The bone cancer excess was based on three observed cases, two of which occurred at a site unrelated to the implant and the site of the third tumor is unknown. Rates of connective tissue cancer and leukemia-lymphoma were not elevated significantly among knee implant recipients. Long-term follow-up (>or= 10 years) did not show a significant excess risk for all cancer (SIR = 1.10; 95% CI = 0.86-1.38) or for any site-specific cancer, including bone cancer, lymphoma, or leukemia. Subgroup analyses for patients with rheumatoid arthritis produced results similar to the overall results.
This epidemiologic study of cancer risk among patients with knee implants is the largest to date. It provides evidence that the incidence of cancer among patients with knee implants is similar to that of the general population. Continued follow-up of this cohort is warranted to evaluate further potential long-term effects of these implants.
随着膝关节植入物越来越普遍，研究其潜在健康风险很重要。我们调查了1980年至1994年在瑞典接受膝关节置换手术的30011名患者的全国性队列中的癌症发生情况。
患者从手术日期后1年开始随访，直至1995年12月31日，累计观察122616人年。平均随访时间为4.3年，2365名患者随访了10年或更长时间。
总体癌症发病率与瑞典普通人群相比没有升高（标准化发病率[SIR]=1.03；95%置信区间[CI]=0.98 - 1.08）。在男性和女性中，所有呼吸道癌症（SIR = 0.73；95% CI = 0.59 - 0.91）和肺癌（SIR = 0.73；95% CI = 0.58 - 0.91）的发病率均降低。男性前列腺癌（SIR = 1.20；95% CI = 1.06 - 1.34）和骨癌（SIR = 6.00；95% CI = 1.24 - 17.52）的发病率升高。骨癌发病率过高是基于观察到的3例病例，其中2例发生在与植入物无关的部位，第三例肿瘤的部位未知。膝关节植入物接受者中结缔组织癌和白血病 - 淋巴瘤的发病率没有显著升高。长期随访（≥10年）未显示所有癌症（SIR = 1.10；95% CI = 0.86 - 1.38）或任何特定部位癌症（包括骨癌、淋巴瘤或白血病）有显著的额外风险。对类风湿性关节炎患者的亚组分析结果与总体结果相似。
这项关于膝关节植入物患者癌症风险的流行病学研究是迄今为止规模最大的。它提供了证据表明膝关节植入物患者的癌症发病率与普通人群相似。有必要对该队列进行持续随访，以进一步评估这些植入物的潜在长期影响。
