与普通人群相比，日本类风湿关节炎患者的恶性肿瘤发病率及淋巴瘤风险。
Incidence of malignancy and the risk of lymphoma in Japanese patients with rheumatoid arthritis compared to the general population.
作者信息
Hashimoto Atsushi, Chiba Noriyuki, Tsuno Hirotaka, Komiya Akiko, Furukawa Hiroshi, Matsui Toshihiro, Nishino Jinju, Tohma Shigeto
机构信息
From the Department of Rheumatology, Department of Clinical Laboratory, and the Clinical Research Center for Allergy and Rheumatology Sagamihara National Hospital, National Hospital Organization, Sagamihara; Department of Rheumatology, Morioka National Hospital, Morioka; and the Nishino Orthopedic Clinic, Tokyo, Japan.A. Hashimoto, MD; T. Matsui, MD; Department of Rheumatology; H. Tsuno, MD; H. Furukawa, MD; S. Tohma, MD; Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology; A. Komiya, MD, Department of Clinical Laboratory, Sagamihara National Hospital, National Hospital Organization; N. Chiba, MD, Department of Rheumatology, Morioka National Hospital, National Hospital Organization; J. Nishino, MD, Nishino Orthopedic Clinic.
出版信息
J Rheumatol. 2015 Apr;42(4):564-71. doi: 10.3899/jrheum.140533. Epub 2015 Jan 15.
OBJECTIVE
Recent advances in the management of patients with rheumatoid arthritis (RA) increased the rates of disease remission and patient life expectancy, while malignancy has become a more common cause of death. Here, we report the incidence of malignancy in a nationwide survey of Japanese patients with RA compared to the general population, focusing on the risk of lymphoma, which often arises in patients with RA.
METHODS
Data on the occurrence of malignancy were collected from patients registered in a nationwide Japanese cohort database, the National Database of Rheumatic Diseases by iR-net in Japan, from 2003 to 2012. To adjust for different population composition and to compare the incidence of malignancy with the general population, standardized incidence rates (SIR) were calculated. To identify risk factors for lymphoma, individual patient data were obtained for multivariate analysis for the year before lymphoma diagnosis.
RESULTS
In 10 years, the cohort composed of 66,953 patient-years yielded 559 malignancies, most frequently lung cancer, followed by gastric cancer, breast cancer, and lymphoma. The overall incidence of malignancies in patients with RA was slightly lower than in the general population (SIR 0.89, 95% CI 0.82-0.97). However, lymphoma risk was significantly higher (SIR 3.43, 95% CI 2.59-4.28), whereas risk of colon, rectal, or liver cancer was lower. Significant risk factors for lymphoma were the use of methotrexate or tacrolimus, and higher age.
CONCLUSION
Patients with RA had no higher overall incidence of malignancies, but lymphoma was significantly more frequent than in the general population.
目的
类风湿关节炎（RA）患者管理方面的最新进展提高了疾病缓解率和患者预期寿命，而恶性肿瘤已成为更常见的死亡原因。在此，我们报告一项针对日本RA患者的全国性调查中恶性肿瘤的发病率，并与普通人群进行比较，重点关注RA患者中常出现的淋巴瘤风险。
方法
从2003年至2012年在日本全国性队列数据库——日本iR-net风湿病国家数据库中登记的患者收集恶性肿瘤发生数据。为调整不同的人群构成并将恶性肿瘤发病率与普通人群进行比较，计算了标准化发病率（SIR）。为确定淋巴瘤的风险因素，获取了淋巴瘤诊断前一年的个体患者数据进行多变量分析。
结果
在10年中，由66,953患者年组成的队列产生了559例恶性肿瘤，最常见的是肺癌，其次是胃癌、乳腺癌和淋巴瘤。RA患者中恶性肿瘤的总体发病率略低于普通人群（SIR 0.89，95%CI 0.82 - 0.97）。然而，淋巴瘤风险显著更高（SIR 3.43，95%CI 2.59 - 4.28），而结肠癌、直肠癌或肝癌的风险较低。淋巴瘤的显著风险因素是使用甲氨蝶呤或他克莫司以及年龄较大。
结论
RA患者的恶性肿瘤总体发病率并不更高，但淋巴瘤比普通人群明显更常见。
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