Yu Kuang-Hui, Kuo Chang-Fu, Huang Lu Hsiang, Huang Wen-Kuan, See Lai-Chu
From the Division of Rheumatology, Allergy, and Immunology (K-HY, C-FK), Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; Department of Public Health (LHH, L-CS), College of Medicine, Chang Gung University; Division of Hematology-Oncology (W-KH), Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine; and Biostatistics Core Laboratory (L-CS), Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
Medicine (Baltimore). 2016 May;95(18):e3540. doi: 10.1097/MD.0000000000003540.
The aim of this study was to determine whether inflammation is related to cancer development, and whether the incidence of cancer is increased and occurs in a site-specific manner in patients with systemic autoimmune rheumatic diseases (SARDs).This study included a nationwide dynamic cohort of patients with various newly diagnosed SARDs from 1997 to 2010 with follow-up until 2012.This study included 75,123 patients with SARDs. During 562,870 person-years of follow-up, 2844 patients developed cancer. Between 1997 and 2010, the highest number of newly diagnosed SARDs cases were rheumatoid arthritis (n = 35,182), followed by systemic lupus erythematosus (SLE, n = 15,623), Sjögren syndrome (n = 11,998), Kawasaki disease (n = 3469), inflammatory bowel disease (n = 2853), scleroderma (n = 1814), Behçet disease (n = 1620), dermatomyositis (n = 1119), polymyositis (n = 811), and vasculitis other than Kawasaki disease (n = 644). A significant standardized incidence ratio (SIR) of overall cancer was observed for patients with SLE (1.41; 95% confidence interval [CI], 1.28-1.56), Sjögren syndrome (1.19; 95% CI, 1.08-1.30), scleroderma (1.27; 95% CI, 1.02-1.59), dermatomyositis (4.79; 95% CI, 4.01-5.73), polymyositis (1.47; 95% CI, 1.05-2.06), vasculitis excluding Kawasaki disease (1.75; 95% CI, 1.20-2.55), and Kawasaki disease (2.88; 95% CI, 1.60-5.20). Overall, patients with most SARDs had a significantly higher risk of inflammation-associated site-specific cancers and hematologic malignancies.This study confirms that autoimmunity is associated with site-specific and hematological malignancies and provides clinical evidence of an association between inflammation and subsequent site-specific cancer development. These findings support the importance of inflammation in site-specific organ system carcinogenesis.
本研究的目的是确定炎症是否与癌症发展相关，以及系统性自身免疫性风湿病（SARDs）患者的癌症发病率是否增加且是否以部位特异性方式发生。本研究纳入了1997年至2010年全国范围内各种新诊断SARDs患者的动态队列，并随访至2012年。本研究纳入了75123例SARDs患者。在562870人年的随访期间，2844例患者患癌。1997年至2010年期间，新诊断SARDs病例数最多的是类风湿关节炎（n = 35182），其次是系统性红斑狼疮（SLE，n = 15623）、干燥综合征（n = 11998）、川崎病（n = 3469）、炎症性肠病（n = 2853）、硬皮病（n = 1814）、白塞病（n = 1620）、皮肌炎（n = 1119）、多发性肌炎（n = 811）以及非川崎病性血管炎（n = 644）。观察到SLE患者（1.41；95%置信区间[CI]，1.28 - 1.56）、干燥综合征患者（1.19；95% CI，1.08 - 1.30）、硬皮病患者（1.27；95% CI，1.02 - 1.59）、皮肌炎患者（4.79；95% CI，4.01 - 5.73）、多发性肌炎患者（1.47；95% CI，1.05 - 2.06）、非川崎病性血管炎患者（1.75；95% CI，1.20 - 2.55）和川崎病患者（2.88；95% CI，1.60 - 5.20）的总体癌症标准化发病比（SIR）显著升高。总体而言，大多数SARDs患者发生炎症相关部位特异性癌症和血液系统恶性肿瘤的风险显著更高。本研究证实自身免疫与部位特异性和血液系统恶性肿瘤相关，并提供了炎症与随后部位特异性癌症发展之间关联的临床证据。这些发现支持了炎症在部位特异性器官系统致癌作用中的重要性。
