Dreyer Lene, Mellemkjaer Lene, Hetland Merete Lund
TA Reumatologisk Klinik 4242, Rigshospitalet, DK-2100 København Ø.
Ugeskr Laeger. 2009 Feb 9;171(7):506-11.
The use of anti-tumour necrosis factor (anti-TNF) therapy is increasing in the treatment of rheumatoid arthritis (RA), spondyloarthropathy, psoriasis and inflammatory bowel disease. It is being debated whether treatment of patients with rheumatic diseases with anti-TNF therapy is associated with an increased cancer incidence.
A descriptive study of cancer cases among 3,688 patients with rheumatic diseases who received anti-TNF therapy was performed. The patients were identified in the nationwide database DANBIO and had a total number of treatment years of 6,092 years. All cancer cases were identified and the cancer diagnoses were subsequently confirmed by medical record review.
A total of 30 cancers in 28 of 3,688 patients were registered in the DANBIO after initiation of anti-TNF therapy in the period from October 2000 to June 2007. Among these six men and 20 women had RA, and two men had Morbus Becterew. The following cancer types were observed: malignant lymphoma 2 (7%), lung 4 (13%), plicae vocalis 2 (7%), breast 4 (13%), pancreatic 3 (10%), colorectal 2 (7%), prostate 1 (3%), malignant melanoma 3 (10%) and non-melanoma skin cancer 9 (30%).
In our descriptive study from the nationwide database DANBIO, a total of 30 cancers were observed in 3,688 patients with rheumatic diseases within a cumulated period of treatment with anti-TNF of 6,092 years. Follow-up for anti-rheumatic and adverse effects in patients in the DANBIO database will continue. Future studies must reveal whether anti-TNF therapy is associated with an increased cancer risk. Planned Danish studies will include relevant control groups and adjustment for confounders.
抗肿瘤坏死因子（抗TNF）疗法在类风湿性关节炎（RA）、脊柱关节病、银屑病和炎症性肠病的治疗中应用日益广泛。抗TNF疗法治疗风湿性疾病患者是否会增加癌症发病率仍存在争议。
对3688例接受抗TNF疗法的风湿性疾病患者中的癌症病例进行了描述性研究。这些患者在全国性数据库DANBIO中被识别，治疗总年限为6092年。识别出所有癌症病例，随后通过病历审查确认癌症诊断。
在2000年10月至2007年6月期间开始抗TNF治疗后，DANBIO中登记了3688例患者中的28例共30例癌症。其中6名男性和20名女性患有RA，2名男性患有贝赫切特病。观察到以下癌症类型：恶性淋巴瘤2例（7%）、肺癌4例（13%）、声带癌2例（7%）、乳腺癌4例（13%）、胰腺癌3例（10%）、结直肠癌2例（7%）、前列腺癌1例（3%）、恶性黑色素瘤3例（10%）和非黑色素瘤皮肤癌9例（30%）。
在我们来自全国性数据库DANBIO的描述性研究中，在3688例风湿性疾病患者接受抗TNF治疗的累计6092年期间共观察到30例癌症。DANBIO数据库中患者的抗风湿和不良反应随访将继续。未来的研究必须揭示抗TNF疗法是否与癌症风险增加有关。丹麦计划开展的研究将包括相关对照组并对混杂因素进行调整。
