Bernatsky Sasha, Boivin Jean-François, Joseph Lawrence, St Pierre Yvan, Moore Andrew, Rajan Raghu, Clarke Ann
Clinical Epidemiology, Montreal General Hospital, Quebec, Canada.
J Rheumatol. 2002 Dec;29(12):2551-4.
There is mounting evidence that hematological malignancies are increased in systemic lupus erythematosus (SLE), and the risk of certain solid tumors may also be increased. The pathogenesis may be different for the 2 processes: risk of hematological malignancies in SLE may be due to chronic lymphocyte stimulation, while risk of solid tumors may be influenced by factors such as obesity and reproductive habits. We aimed to determine prevalence in a lupus cohort of selected factors that influence the risk of cancer, and to compare this prevalence to that of the general population.
Subjects were women followed in the Montreal General Hospital Lupus Clinic. We administered a postal survey of factors known to be associated with lung and aerodigestive cancers (smoking, alcohol use) as well as factors associated with breast and gynecologic cancers (nulliparity, use of oral contraceptives, and hormone replacement therapy). For patients who had died or been lost to followup, data were abstracted from clinic records. Information about nonsteroidal antiinflammatory drug (NSAID) use (a potentially protective factor for colorectal cancer) was also collected. Obesity prevalence was established from the clinic database. Comparison figures were obtained from the 1996-1997 National Population Health Survey data for Quebec women and age adjusted, where possible.
Compared to the general population, the lupus population had lower prevalence of current use of oral contraceptives, and greater prevalence of obesity and nulliparity. The average number of pack-years among smokers was also greater in the lupus cohort.
Solid cancer incidence in SLE may be influenced by established cancer risk factors such as smoking, obesity, and reproductive history.
越来越多的证据表明，系统性红斑狼疮（SLE）患者血液系统恶性肿瘤的发病率增加，某些实体瘤的风险也可能增加。这两个过程的发病机制可能不同：SLE患者血液系统恶性肿瘤的风险可能归因于慢性淋巴细胞刺激，而实体瘤的风险可能受肥胖和生殖习惯等因素影响。我们旨在确定狼疮队列中影响癌症风险的选定因素的患病率，并将该患病率与普通人群的患病率进行比较。
研究对象为在蒙特利尔综合医院狼疮诊所随访的女性。我们通过邮寄问卷的方式调查了已知与肺癌和上呼吸道消化道癌症相关的因素（吸烟、饮酒）以及与乳腺癌和妇科癌症相关的因素（未生育、口服避孕药的使用和激素替代疗法）。对于已死亡或失访的患者，数据从临床记录中提取。还收集了有关非甾体抗炎药（NSAID）使用情况（结直肠癌的潜在保护因素）的信息。肥胖患病率根据诊所数据库确定。比较数据尽可能从1996 - 1997年魁北克女性全国人口健康调查数据中获取并进行年龄调整。
与普通人群相比，狼疮患者口服避孕药的当前使用率较低，肥胖和未生育的患病率较高。狼疮队列中吸烟者的包年数平均值也更高。
SLE患者实体癌的发病率可能受吸烟、肥胖和生殖史等既定癌症风险因素的影响。
