免疫球蛋白G4相关疾病与诊断后12年内恶性肿瘤的关联：长期随访后的分析
Association Between Immunoglobulin G4-related Disease and Malignancy within 12 Years after Diagnosis: An Analysis after Longterm Followup.
作者信息
Asano Junpei, Watanabe Takayuki, Oguchi Takaya, Kanai Keita, Maruyama Masahiro, Ito Tetsuya, Muraki Takashi, Hamano Hideaki, Arakura Norikazu, Matsumoto Akihiro, Kawa Shigeyuki
机构信息
From the Department of Gastroenterology, the Endoscopic Examination Center, and the Center for Health, Safety, and Environmental Management, Shinshu University School of Medicine, Matsumoto, Japan.J. Asano, MD, Department of Gastroenterology, Shinshu University School of Medicine; T. Watanabe, MD, PhD, Department of Gastroenterology, Shinshu University School of Medicine; T. Oguchi, MD, Department of Gastroenterology, Shinshu University School of Medicine; K. Kanai, MD, Department of Gastroenterology, Shinshu University School of Medicine; M. Maruyama, MD, PhD, Department of Gastroenterology, Shinshu University School of Medicine; T. Ito, MD, PhD, Department of Gastroenterology, Shinshu University School of Medicine; T. Muraki, MD, PhD, Department of Gastroenterology, Shinshu University School of Medicine; H. Hamano, MD, PhD, Department of Gastroenterology, Shinshu University School of Medicine; N. Arakura, MD, PhD, Endoscopic Examination Center, Shinshu University School of Medicine; A. Matsumoto, MD, PhD, Department of Gastroenterology, Shinshu University School of Medicine; S. Kawa, MD, PhD, Center for Health, Safety, and Environmental Management, Shinshu University.
出版信息
J Rheumatol. 2015 Nov;42(11):2135-42. doi: 10.3899/jrheum.150436. Epub 2015 Oct 15.
OBJECTIVE
Because it is uncertain whether immunoglobulin G4-related disease (IgG4-RD) is associated with malignancy, we evaluated the incidence of cancer development in a large cohort of patients with IgG4-RD.
METHODS
The study enrolled 158 patients diagnosed as having IgG4-RD between 1992 and 2012. We calculated the standardized incidence ratio (SIR) and cumulative rate of malignancies in this group and searched for risk factors associated with the occurrence of tumors.
RESULTS
A total of 34 malignancies were observed in the patients with IgG4-RD over a mean followup period of 5.95 ± 4.48 years. The overall SIR of malignancies was 2.01 (95% CI 1.34-2.69). The SIR of patients who exhibited a tumor within 1 year after IgG4-RD diagnosis was 3.53 (95% CI 1.23-5.83), while that of subjects forming a malignancy in subsequent years was 1.48 (95% CI 0.99-1.98). The cumulative rate of malignancy development was significantly higher in patients with IgG4-RD within 12 years after diagnosis than in the Japanese general population. Comparable results were obtained for an autoimmune pancreatitis subgroup. The serum concentrations of several disease activity markers at diagnosis were significantly higher in patients with malignancies than in those without.
CONCLUSION
We identified a close association between IgG4-RD and malignancy formation within 12 years after diagnosis, particularly during the first year. An active IgG4-RD state is presumed to be a strong risk factor for malignancy development.
目的
由于免疫球蛋白G4相关疾病（IgG4-RD）是否与恶性肿瘤相关尚不确定，我们评估了一大群IgG4-RD患者中癌症发生的发生率。
方法
该研究纳入了1992年至2012年间被诊断为患有IgG4-RD的158例患者。我们计算了该组恶性肿瘤的标准化发病率（SIR）和累积发生率，并寻找与肿瘤发生相关的危险因素。
结果
在平均随访期为5.95±4.48年的IgG4-RD患者中，共观察到34例恶性肿瘤。恶性肿瘤的总体SIR为2.01（95%CI 1.34-2.69）。IgG4-RD诊断后1年内出现肿瘤的患者的SIR为3.53（95%CI 1.23-5.83），而在随后几年形成恶性肿瘤的患者的SIR为1.48（95%CI 0.99-1.98）。诊断后12年内，IgG4-RD患者的恶性肿瘤累积发生率显著高于日本普通人群。自身免疫性胰腺炎亚组也获得了类似的结果。诊断时，有恶性肿瘤的患者的几种疾病活动标志物的血清浓度显著高于无恶性肿瘤的患者。
结论
我们发现IgG4-RD与诊断后12年内的恶性肿瘤形成密切相关，尤其是在第一年。活跃的IgG4-RD状态被认为是恶性肿瘤发生的一个强危险因素。
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