Department of Neurology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Neuroimmunology Unit, Department of Clinical Neuroscience and Centre for Molecular Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Sweden.
Eur J Neurol. 2015 Jul;22(7):1074-80. doi: 10.1111/ene.12710. Epub 2015 Apr 22.
A reduced cancer risk amongst patients with multiple sclerosis (MS) has been reported. Theoretically, this could represent a genuine reduction in risk or, alternatively, 'diagnostic neglect', where cancer is undiagnosed when symptoms are misattributed to MS.
Assess all-cause mortality risk following a cancer diagnosis in patients with MS compared with a cohort without MS.
A cohort of MS patients (n = 19,364) and a cohort of the general population (n = 192,519) were extracted from national Swedish registers from 1969 to 2005. All-cause mortality after cancer in MS was compared with the general population. Poisson regression analysis was conducted in the MS and non-MS cohorts separately. The models were adjusted for follow-up duration, year at entry, sex, region and socioeconomic index. The two cohorts were combined and differences in mortality risk were assessed using interaction testing.
The adjusted relative risk (and 95% confidence interval) for all-cause mortality following a cancer diagnosis in MS patients (compared with MS patients without cancer) is 3.06 (2.86-3.27; n = 1768) and amongst those without MS 5.73 (5.62-5.85; n = 24,965). This lower magnitude mortality risk in the MS patients was confirmed by multiplicative interaction testing (P < 0.001).
A consistent pattern of lower magnitude of all-cause mortality risk following cancer in MS patients for a range of organ-specific cancer types was found. It suggests that cancer diagnoses tend not to be delayed in MS and diagnostic neglect is unlikely to account for the reduced cancer risk associated with MS. The lower magnitude cancer risk in MS may be due to disease-associated characteristics or exposures.
多发性硬化症（MS）患者的癌症风险降低已被报道。从理论上讲，这可能代表风险的真实降低，或者是“诊断疏忽”，即当症状归因于 MS 时，癌症未被诊断。
评估 MS 患者癌症诊断后的全因死亡率与无 MS 患者相比。
从 1969 年至 2005 年，从国家瑞典登记处提取了 MS 患者队列（n=19364）和一般人群队列（n=192519）。将 MS 患者的全因死亡率与一般人群进行比较。在 MS 和非 MS 队列中分别进行了泊松回归分析。模型根据随访时间、进入年份、性别、地区和社会经济指数进行了调整。将两个队列合并，并使用交互检验评估死亡率风险的差异。
调整后的相对风险（和 95%置信区间）为 MS 患者癌症诊断后全因死亡率（与无癌症的 MS 患者相比）为 3.06（2.86-3.27；n=1768），无 MS 患者为 5.73（5.62-5.85；n=24965）。MS 患者中这种较低的全因死亡率风险通过乘法交互检验得到了证实（P<0.001）。
对于一系列特定于器官的癌症类型，在 MS 患者中发现了癌症后全因死亡率风险幅度较低的一致模式。这表明癌症诊断在 MS 中不太可能被延迟，并且诊断疏忽不太可能解释与 MS 相关的降低的癌症风险。MS 中较低的癌症风险可能是由于疾病相关的特征或暴露。
