van Daalen Emma E, Rahmattulla Chinar, Wolterbeek Ron, Bruijn Jan A, Bajema Ingeborg M
From the Department of Pathology, and the Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
E.E. van Daalen, BSc, Department of Pathology, Leiden University Medical Center; C. Rahmattulla, BSc, Department of Pathology, Leiden University Medical Center; R. Wolterbeek, MD, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center; J.A. Bruijn, MD, PhD, Department of Pathology, Leiden University Medical Center; and I.M. Bajema, MD, PhD, Department of Pathology, Leiden University Medical Center.
J Rheumatol. 2017 Mar;44(3):314-318. doi: 10.3899/jrheum.160885. Epub 2017 Jan 15.
Previous studies have reported an increased malignancy risk preceding antineutrophil cytoplasmic antibody-associated vasculitis (AAV), suggesting common pathogenic pathways in these 2 entities. However, the study results were conflicting and often limited to patients with granulomatosis with polyangiitis (GPA). Here, we study the malignancy risk prior to AAV diagnosis [either GPA or microscopic polyangiitis (MPA)] to elaborate on the putative association between malignancy and AAV.
A total of 203 patients were selected for the current study. Malignancies prior to AAV diagnosis were identified using a nationwide pathology database, and their occurrence was verified by reviewing the medical files of 145 patients (71.4%). The malignancy incidence was compared to the general population by calculation of standardized incidence ratios (SIR), matching for sex, age, and time period. SIR were calculated for 2 intervals: < 2 years and ≥ 2 years prior to AAV diagnosis. Separate analyses were performed for GPA and MPA.
The overall risk for malignancy prior to AAV diagnosis was similar to that of the general population (SIR 0.96, 95% CI 0.55-1.57), as was true when risks were analyzed by malignancy type, including skin, bladder, kidney, lung, stomach, rectum, and uterus (SIR ranged from 1.64 to 4.14). We found no significant difference in malignancy risk between patients with GPA and MPA.
Our findings do not support the hypothesis that preceding malignancies and AAV have a causal relationship or shared pathogenic pathways.
既往研究报告抗中性粒细胞胞浆抗体相关性血管炎（AAV）发病前恶性肿瘤风险增加，提示这两种疾病存在共同致病途径。然而，研究结果相互矛盾，且通常仅限于肉芽肿性多血管炎（GPA）患者。在此，我们研究AAV（GPA或显微镜下多血管炎（MPA））诊断前的恶性肿瘤风险，以阐明恶性肿瘤与AAV之间的假定关联。
本研究共纳入203例患者。利用全国病理数据库确定AAV诊断前的恶性肿瘤，并通过查阅145例患者（71.4%）的病历进行核实。通过计算标准化发病比（SIR），并根据性别、年龄和时间段进行匹配，将恶性肿瘤发病率与普通人群进行比较。在AAV诊断前<2年和≥2年这两个时间段计算SIR。对GPA和MPA分别进行分析。
AAV诊断前的总体恶性肿瘤风险与普通人群相似（SIR 0.96，95%CI 0.55-1.57），按恶性肿瘤类型分析风险时也是如此，包括皮肤、膀胱、肾脏、肺、胃、直肠和子宫（SIR范围为1.64至4.14）。我们发现GPA和MPA患者的恶性肿瘤风险无显著差异。
我们的研究结果不支持先前恶性肿瘤与AAV存在因果关系或共同致病途径这一假设。
