系统性红斑狼疮中的恶性肿瘤：台湾的全国队列研究。

Malignancy in systemic lupus erythematosus: a nationwide cohort study in Taiwan.

机构信息

Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.

出版信息

Am J Med. 2010 Dec;123(12):1150.e1-6. doi: 10.1016/j.amjmed.2010.08.006.

DOI:10.1016/j.amjmed.2010.08.006

PMID:21183006

Abstract

BACKGROUND

an increased risk of malignancy in patients with systemic lupus erythematosus has been reported, but rarely in Asian populations. We aimed to investigate the relative risk of cancer and to identify the high-risk group for cancer in patients with lupus.

METHODS

we conducted a retrospective, nationwide cohort study that included 11,763 patients with lupus without a history of malignancies, using the national health insurance database of Taiwan from 1996 to 2007. Standardized incidence ratios (SIRs) of cancers were analyzed.

RESULTS

a total of 259 cancers were observed in patients with lupus. An elevated risk of cancer among those with systemic lupus erythematosus was noted (SIR 1.76; 95% confidence interval [CI] 1.74-1.79), especially for hematologic malignancies (SIR 4.96; 95% CI 4.79-5.14). Younger patients had a greater risk ratio of cancer than the general population, and the risk ratio decreased with age. The risk ratio of cancer decreased with time, yet remained elevated compared with that of the general population. The risk of non-Hodgkin lymphoma was greatest (SIR 7.27) among hematologic cancers. Among solid tumors, the risk was greatest for cancers of the vagina/vulva (SIR 4.76), nasopharynx (SIR 4.18), and kidney (SIR 3.99). An elevated risk for less common cancers, including those of the brain, oropharynx, and thyroid glands, was also observed.

CONCLUSION

patients with lupus are at increased risk of cancers and should receive age- and gender-appropriate malignancy evaluations, with additional assessment for vulva/vagina, kidney, nasopharynx, and hematologic malignancy. Continued vigilance for development of cancers in follow-up is recommended.

摘要

背景

系统性红斑狼疮患者的恶性肿瘤风险增加已有报道，但在亚洲人群中很少见。我们旨在调查癌症的相对风险，并确定狼疮患者的癌症高危人群。

方法

我们进行了一项回顾性、全国性队列研究，纳入了 1996 年至 2007 年期间来自台湾全民健康保险数据库的 11763 例无恶性肿瘤病史的狼疮患者。分析了癌症的标准化发病比（SIR）。

结果

共观察到 259 例狼疮患者发生癌症。系统性红斑狼疮患者的癌症风险升高（SIR 1.76；95%置信区间 [CI] 1.74-1.79），尤其是血液恶性肿瘤（SIR 4.96；95%CI 4.79-5.14）。年轻患者的癌症风险比高于普通人群，且随着年龄的增长风险比降低。癌症风险随时间下降，但仍高于普通人群。血液恶性肿瘤中，非霍奇金淋巴瘤的风险比最大（SIR 7.27）。在实体肿瘤中，阴道/外阴（SIR 4.76）、鼻咽（SIR 4.18）和肾脏（SIR 3.99）的癌症风险最大。还观察到一些罕见癌症（如脑、口咽和甲状腺）的风险增加。