Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Ann Oncol. 2012 Aug;23(8):2179-2184. doi: 10.1093/annonc/mdr590. Epub 2012 Jan 6.
Patients with some autoimmune diseases (AIDs) are at increased risk of cancer, possibly a result of an underlying dysregulation of the immune system, medication, treatment or, probably, surveillance bias. Data on cancer mortality and survival in patients previously diagnosed with AIDs would provide novel information on these comorbidities and their clinical implications.
Standardized mortality ratios (SMRs) and hazard ratios (HRs) were calculated for subsequent deaths from seven digestive tract cancers between 1964 and 2008 in patients hospitalized for any of 33 AIDs.
There were 33 increased SMRs for specific cancers after a defined AID; similarly, 21 HRs were increased. Both the SMR and HR were increased after 10 autoimmune disorders, including pernicious anemia, systemic lupus erythematosus and psoriasis. Increased SMRs and unchanged HRs were noted for 23 cancers. Myasthenia gravis was associated with SMRs for five cancers but no increases in HRs. For nine cancers, including esophageal cancer after ulcerative colitis and rheumatoid arthritis, the SMR was unchanged but the HR increased.
The increases in SMRs provide evidence that cancer risks were truly increased and largely unaffected by surveillance bias. The prognostic survival data should contribute to clinical evaluation and therapeutic planning.
某些自身免疫性疾病（AIDs）患者的癌症风险增加，这可能是由于免疫系统的潜在失调、药物、治疗或可能的监测偏差。先前诊断为自身免疫性疾病的患者的癌症死亡率和生存数据将为这些合并症及其临床意义提供新的信息。
计算了 1964 年至 2008 年间因任何 33 种自身免疫性疾病住院的患者中七种消化道癌症随后死亡的标准化死亡率比（SMRs）和风险比（HRs）。
在明确的自身免疫性疾病后，有 33 种特定癌症的 SMR 增加；同样，21 种 HR 也增加。包括恶性贫血、系统性红斑狼疮和银屑病在内的 10 种自身免疫性疾病后，SMR 和 HR 均增加。23 种癌症的 SMR 增加，HR 不变。重症肌无力与五种癌症的 SMR 相关，但 HR 无增加。对于包括溃疡性结肠炎和类风湿性关节炎后的食管癌在内的九种癌症，SMR 不变，但 HR 增加。
SMRs 的增加提供了证据表明癌症风险确实增加了，并且在很大程度上不受监测偏差的影响。预后生存数据应有助于临床评估和治疗计划。
