接受硫唑嘌呤治疗炎症性肠病患者患尿路癌的额外风险：一项前瞻性观察队列研究。
Excess risk of urinary tract cancers in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study.
作者信息
Bourrier A, Carrat F, Colombel J-F, Bouvier A-M, Abitbol V, Marteau P, Cosnes J, Simon T, Peyrin-Biroulet L, Beaugerie L
机构信息
Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, Paris, France.
ERL 1057 INSERM/UMRS 7203 and GRC-UPMC 03, UPMC Univ Paris 06, Paris, France.
出版信息
Aliment Pharmacol Ther. 2016 Jan;43(2):252-61. doi: 10.1111/apt.13466. Epub 2015 Nov 9.
BACKGROUND
The risk of urinary tract cancers, including kidney and bladder cancers, was increased in transplant recipients receiving thiopurines.
AIM
To assess the risk of urinary tract cancers in patients with inflammatory bowel disease (IBD) receiving thiopurines in the CESAME observational cohort.
METHODS
Between May 2004 and June 2005, 19 486 patients with IBD, 30.1% of whom were receiving thiopurines, were enrolled. Median follow-up was 35 months (IQR: 29-40).
RESULTS
Ten and six patients developed respectively kidney and bladder cancer. The incidence rates of urinary tract cancer were 0.48/1000 patient-years in patients receiving thiopurines (95% CI: 0.21-0.95), 0.10/1000 patient-years in patients who discontinued thiopurines (95% CI: 0.00-0.56) and 0.30/1000 patient-years in patients never treated with thiopurines (95% CI: 0.12-0.62) at entry. The standardised incidence ratio of urinary tract cancer was 3.40 (95% CI: 1.47-6.71, P = 0.006) in patients receiving thiopurines, 0.64 (95% CI: 0.01-3.56, P = 0.92) in patients previously exposed to thiopurines and 1.17 (95% CI: 0.47-12.42, P = 0.78) in patients never treated with thiopurines. The multivariate-adjusted hazard ratio (HR) of urinary tract cancer between patients receiving thiopurines and those not receiving thiopurines was 2.82 (95% CI: 1.04-7.68, P = 0.04). Other significant risk factors were male gender (HR: 3.98, 95% CI: 1.12-14.10, P = 0.03) and increasing age (HR after 65 years (ref <50): 13.26, 95% CI: 3.52-50.03, P = 0.0001).
CONCLUSION
Patients with IBD receiving thiopurines have an increased risk of urinary tract cancers. Clinically relevant excess risk is observed in older men.
背景
接受硫唑嘌呤的移植受者患泌尿系统癌症（包括肾癌和膀胱癌）的风险增加。
目的
在CESAME观察性队列中评估接受硫唑嘌呤的炎症性肠病（IBD）患者患泌尿系统癌症的风险。
方法
2004年5月至2005年6月，纳入了19486例IBD患者，其中30.1%正在接受硫唑嘌呤治疗。中位随访时间为35个月（四分位间距：29 - 40个月）。
结果
分别有10例和6例患者发生肾癌和膀胱癌。接受硫唑嘌呤治疗的患者泌尿系统癌症发病率为0.48/1000人年（95%置信区间：0.21 - 0.95），停用硫唑嘌呤的患者为0.10/1000人年（95%置信区间：0.00 - 0.56），入组时从未接受硫唑嘌呤治疗的患者为0.30/1000人年（95%置信区间：0.12 - 0.62）。接受硫唑嘌呤治疗的患者泌尿系统癌症标准化发病比为3.40（95%置信区间：1.47 - 6.71，P = 0.006），既往接触过硫唑嘌呤的患者为0.64（95%置信区间：0.01 - 3.56，P = 0.92），从未接受硫唑嘌呤治疗的患者为1.17（95%置信区间：0.47 - 12.42，P = 0.78）。接受硫唑嘌呤治疗的患者与未接受硫唑嘌呤治疗的患者相比，泌尿系统癌症的多因素调整风险比（HR）为2.82（95%置信区间：1.04 - 7.68，P = 0.04）。其他显著的风险因素为男性（HR：3.98，95%置信区间：1.12 - 14.10，P = 0.03）和年龄增长（65岁及以上（参照<50岁）的HR：13.26，95%置信区间：3.52 - 50.03，P = 0.0001）。
结论
接受硫唑嘌呤的IBD患者患泌尿系统癌症的风险增加。在老年男性中观察到具有临床意义的额外风险。
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