皮肤癌、类风湿性关节炎与肿瘤坏死因子抑制剂
Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors.
作者信息
Chakravarty Eliza F, Michaud Kaleb, Wolfe Frederick
机构信息
Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.
出版信息
J Rheumatol. 2005 Nov;32(11):2130-5.
OBJECTIVE
To determine the rates of reported non-melanoma skin cancer (NMSC) in a large cohort of patients with rheumatoid arthritis (RA) in comparison to patients with osteoarthritis (OA) and to determine risk factors for the development of NMSC in patients with RA.
METHODS
Self-reported information from 15,789 patients with RA and 3,639 patients with OA were collected through semi-annual questionnaires since 1999. Survival analyses were used to determine incidence rates for NMSC among patients with RA and OA. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HR) for the development of NMSC. Separate analyses were performed for patients with RA to explore associations between use of immunosuppressive medication and development of NMSC.
RESULTS
The crude (unadjusted) incidence rate for reported NMSC among patients with RA and OA were 18.1 and 20.4 per 1000 patient years, respectively. OA patients were older, more likely to be Caucasian, and had higher past incidence of NMSC. Age, male sex, Caucasian race, and history of NMSC prior to entry into the database were associated with an increased risk of NMSC in multivariate Cox proportional hazard models. After adjustment for covariates, RA was associated with an increased risk of NMSC (HR 1.19, p = 0.042). Among RA patients, the development of NMSC was associated with use of prednisone (HR 1.28, p = 0.014) and tumor necrosis factor (TNF) inhibitors alone or with concomitant methotrexate (HR 1.24, p = 0.89 and HR 1.97, p = 0.001, respectively) in addition to established risk factors including fair skin, age, male sex, and previous history of NMSC. No association was found between use of methotrexate or leflunomide and development of NMSC (HR 1.12, p = 0.471, HR 0.83, p = 0.173, respectively).
CONCLUSION
In this large, national cohort, RA was associated with an increased risk for development of NMSC. Among patients with RA, use of TNF inhibitors and prednisone were associated with an increased risk of NMSC.
目的
确定一大群类风湿关节炎（RA）患者中报告的非黑色素瘤皮肤癌（NMSC）发生率，并与骨关节炎（OA）患者进行比较，同时确定RA患者发生NMSC的危险因素。
方法
自1999年以来，通过半年一次的问卷调查收集了15789例RA患者和3639例OA患者的自我报告信息。生存分析用于确定RA和OA患者中NMSC的发病率。多变量Cox比例风险模型用于估计NMSC发生的风险比（HR）。对RA患者进行单独分析，以探讨免疫抑制药物的使用与NMSC发生之间的关联。
结果
RA和OA患者中报告的NMSC的粗（未调整）发病率分别为每1000患者年18.1例和20.4例。OA患者年龄更大，更可能是白种人，且既往NMSC发病率更高。在多变量Cox比例风险模型中，年龄、男性、白种人种族以及进入数据库之前的NMSC病史与NMSC风险增加相关。在对协变量进行调整后，RA与NMSC风险增加相关（HR 1.19，p = 0.042）。在RA患者中，除了包括皮肤白皙、年龄、男性以及既往NMSC病史等已确定的危险因素外，NMSC的发生还与单独使用泼尼松（HR 1.28，p = 0.014）以及单独使用或与甲氨蝶呤联合使用的肿瘤坏死因子（TNF）抑制剂相关（分别为HR 1.24，p = 0.89和HR 1.97，p = 0.001）。未发现使用甲氨蝶呤或来氟米特与NMSC发生之间存在关联（分别为HR 1.12，p = 0.471，HR 0.83，p = 0.173）。
结论
在这个大型的全国队列中，RA与发生NMSC的风险增加相关。在RA患者中，使用TNF抑制剂和泼尼松与NMSC风险增加相关。
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