Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1066-73. doi: 10.2215/CJN.08880813. Epub 2014 May 22.
Cyclophosphamide treatment improves renal survival in patients with idiopathic membranous nephropathy. However, use of cyclophosphamide is associated with cancer. The incidence of malignancies in patients with idiopathic membranous nephropathy was evaluated, and the cancer risk associated with cyclophosphamide use was estimated.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients who attended the clinic were included prospectively from 1995 on. A crude incidence ratio for the occurrence of malignancy was calculated. Incidence ratios were subsequently standardized to potential confounders. Latency between cyclophosphamide therapy and the occurrence of cancer was estimated by stratifying for time since the start of treatment. Finally, Poisson regression was used to obtain a multiple adjusted incidence ratio and investigate the dose-response relationship between cyclophosphamide and cancer.
Data were available for 272 patients; the mean age was 51 years, and 70% of the patients were men. Median follow-up was 6.0 years (interquartile range=3.6-9.5), and 127 patients were treated with cyclophosphamide. Cancer incidence was 21.2 per 1000 person-years in treated patients compared with 4.6 per 1000 person-years in patients who did not receive cyclophosphamide, resulting in crude and adjusted incidence ratios of 4.6 (95% confidence interval, 1.5 to 18.8) and 3.2 (95% confidence interval, 1.0 to 9.5), respectively.
Cyclophosphamide therapy in idiopathic membranous nephropathy gives a threefold increase in cancer risk. For the average patient, this finding translates into an increase in annual risk from approximately 0.3% to 1.0%. The increased risk of malignancy must be balanced against the improved renal survival.
环磷酰胺治疗可改善特发性膜性肾病患者的肾脏存活率。然而，环磷酰胺的使用与癌症有关。本研究评估了特发性膜性肾病患者的恶性肿瘤发病率，并估计了环磷酰胺使用相关的癌症风险。
设计、设置、参与者和测量方法：1995 年以来，前瞻性纳入在诊所就诊的患者。计算了恶性肿瘤发生的粗发病率比。随后，根据潜在混杂因素对发病率比进行了标准化。通过分层治疗开始后的时间来估计环磷酰胺治疗与癌症发生之间的潜伏期。最后，使用泊松回归获得多个调整后的发病率比，并调查环磷酰胺与癌症之间的剂量反应关系。
共纳入 272 例患者，平均年龄为 51 岁，70%为男性。中位随访时间为 6.0 年（四分位间距为 3.6-9.5），127 例患者接受了环磷酰胺治疗。治疗患者的癌症发病率为每 1000 人年 21.2 例，而未接受环磷酰胺治疗的患者为每 1000 人年 4.6 例，导致粗发病率比和调整发病率比分别为 4.6（95%置信区间，1.5 至 18.8）和 3.2（95%置信区间，1.0 至 9.5）。
在特发性膜性肾病中使用环磷酰胺治疗会使癌症风险增加三倍。对于一般患者，这一发现将每年的风险从约 0.3%增加到 1.0%。必须权衡恶性肿瘤风险的增加与改善的肾脏存活率。
