Bernatsky S, Boivin J F, Joseph L, Rajan R, Zoma A, Manzi S, Ginzler E, Urowitz M, Gladman D, Fortin P R, Petri M, Edworthy S, Barr S, Gordon C, Bae S C, Sibley J, Isenberg D, Rahman A, Aranow C, Dooley M A, Steinsson K, Nived O, Sturfelt G, Alarcón G, Senécal J L, Zummer M, Hanly J, Ensworth S, Pope J, El-Gabalawy H, McCarthy T, St Pierre Y, Ramsey-Goldman R, Clarke A
Montreal General Hospital, Montreal, Quebec, Canada.
Arthritis Rheum. 2005 May;52(5):1481-90. doi: 10.1002/art.21029.
There is increasing evidence in support of an association between systemic lupus erythematosus (SLE) and malignancy, but in earlier studies the association could not be quantified precisely. The present study was undertaken to ascertain the incidence of cancer in SLE patients, compared with that in the general population.
We assembled a multisite (23 centers) international cohort of patients diagnosed as having SLE. Patients at each center were linked to regional tumor registries to determine cancer occurrence. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Cancers expected were determined by multiplying person-years in the cohort by the geographically matched age, sex, and calendar year-specific cancer rates, and summing over all person-years.
The 9,547 patients from 23 centers were observed for a total of 76,948 patient-years, with an average followup of 8 years. Within the observation interval, 431 cancers occurred. The data confirmed an increased risk of cancer among patients with SLE. For all cancers combined, the SIR estimate was 1.15 (95% confidence interval [95% CI] 1.05-1.27), for all hematologic malignancies, it was 2.75 (95% CI 2.13-3.49), and for non-Hodgkin's lymphoma, it was 3.64 (95% CI 2.63-4.93). The data also suggested an increased risk of lung cancer (SIR 1.37; 95% CI 1.05-1.76), and hepatobiliary cancer (SIR 2.60; 95% CI 1.25, 4.78).
These results support the notion of an association between SLE and cancer and more precisely define the risk of non-Hodgkin's lymphoma in SLE. It is not yet known whether this association is mediated by genetic factors or exogenous exposures.
越来越多的证据支持系统性红斑狼疮（SLE）与恶性肿瘤之间存在关联，但在早期研究中，这种关联无法精确量化。本研究旨在确定SLE患者中癌症的发病率，并与普通人群进行比较。
我们组建了一个多中心（23个中心）的国际队列，纳入被诊断为患有SLE的患者。每个中心的患者与区域肿瘤登记处进行关联，以确定癌症的发生情况。标准化发病率（SIR）计算为观察到的癌症病例数与预期癌症病例数之比。预期癌症病例数通过将队列中的人年数乘以地理匹配的年龄、性别和特定日历年份的癌症发病率，并对所有人年数求和来确定。
来自23个中心的9547例患者共被观察了76948人年，平均随访时间为8年。在观察期内，发生了431例癌症。数据证实SLE患者患癌症的风险增加。对于所有癌症合并计算，SIR估计值为1.15（95%置信区间[95%CI]1.05 - 1.27），对于所有血液系统恶性肿瘤，为2.75（95%CI 2.13 - 3.49），对于非霍奇金淋巴瘤，为3.64（95%CI 2.63 - 4.93）。数据还提示肺癌（SIR 1.37；95%CI 1.05 - 1.76）和肝胆癌（SIR 2.60；95%CI 1.25，4.78）的风险增加。
这些结果支持SLE与癌症之间存在关联的观点，并更精确地界定了SLE患者中非霍奇金淋巴瘤的风险。目前尚不清楚这种关联是由遗传因素还是外源性暴露介导的。
