Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Ann Oncol. 2011 Jun;22(6):1427-1434. doi: 10.1093/annonc/mdq614. Epub 2010 Dec 24.
Sarcoidosis has been reported to be associated with an increased risk of cancer; however, little information is available about the prognosis for sarcoidosis patients diagnosed with cancer.
A population-based cohort of sarcoidosis patients was identified from Swedish registers. Cause-specific and overall hazard ratios (HRs) were estimated by using Cox regression model to show the probability of death in the study group compared with the control population.
A total of 1167 sarcoidosis patients were identified with subsequent cancer compared with 1,023,725 cancer patients without sarcoidosis from 1964 to 2006, showing a significant survival disparity [overall HR 1.21, 95% confidence interval (CI) 1.13-1.30 and cause-specific HR 1.16, 95% CI 1.08-1.27]. Site-specific analyses revealed that an overall mortality excess in sarcoidosis patients was observed for six cancers in comparison with a cancer-specific mortality excess for four cancers. Notably, stratified analyses showed that the prognosis was worse for cancer patients diagnosed below age 65 years. Cancer sites with significant mortality excess after sarcoidosis were mutually exclusive for men and women.
A previously diagnosed sarcoidosis worsens the prognosis of cancer, preferentially for those diagnosed at a relatively younger age. The underlying mechanisms and more prognostic factors warrant further investigation.
已有报告显示，结节病与癌症风险增加相关；然而，关于诊断患有癌症的结节病患者的预后情况，相关信息有限。
本研究从瑞典登记处确定了一个结节病患者的基于人群的队列。采用 Cox 回归模型估计特定病因和总体风险比（HR），以显示与对照组相比，研究组的死亡概率。
在 1964 年至 2006 年间，共发现 1167 例结节病患者随后被诊断患有癌症，而在没有结节病的 1023725 例癌症患者中，存在显著的生存差异[总体 HR 为 1.21，95%置信区间（CI）为 1.13-1.30；特定病因 HR 为 1.16，95%CI 为 1.08-1.27]。特定部位分析显示，与癌症特异性死亡率增加相比，与六种癌症相比，结节病患者的总体死亡率过高。值得注意的是，分层分析表明，在年龄<65 岁的癌症患者中，预后更差。在结节病后具有显著死亡率过高的癌症部位，在男性和女性之间是相互排斥的。
先前诊断的结节病会使癌症的预后恶化，尤其是在相对较年轻的年龄诊断的患者中。需要进一步研究潜在的机制和更多的预后因素。
