Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, C/Camino del Molino, 2, 28942, Fuenlabrada, Madrid, Spain.
Department of Internal Medicine, Hospital Universitario de Guadalajara, Universidad de Alcalá, C/Donante de Sangre, s/n, 19002 Guadalajara, Spain.
Autoimmun Rev. 2017 May;16(5):461-468. doi: 10.1016/j.autrev.2017.03.012. Epub 2017 Mar 8.
Emerging data have shown an increased risk of malignancy among patients diagnosed with systemic sclerosis (SSc) so identification of risk factors linking both disorders might have prognostic implications. The aim of this study was to assess the clinical and treatment-related risk factors for cancer in a single-center cohort of patients with SSc.
Demographic, clinical, capillaroscopic, immunological and treatment-related data from 432 consecutive SSc patients were retrospectively analyzed. Variables that reached significant association in the univariate analysis were entered into a logistic regression in order to identify independent risk factors for cancer.
Malignancy was diagnosed in 53 patients (12.2%). Fifty-eight neoplasms were identified, among which breast (n=15), lung (n=10) and hematologic (n=9) malignancies were the most prevalent. In 19 patients the diagnosis of both scleroderma and tumour was made in <3years apart. Cancer significantly decreased the probability of survival (OR=2.61; 95%CI 1.46-4.69; p=0.001). No association with age, sex, smoking, cutaneous subset or RNA polymerase-III antibodies was found. However, risk of cancer was directly associated with the presence of anti-PM/Scl antibodies (OR=3.90; 95%CI 1.31-11.61; p=0.014), and inversely related to aspirin use (OR=0.33; 95%CI 0.12-0.90; p=0.031), which remained as independent risk factors for cancer on multivariate analysis.
PM/Scl antibodies seem to be associated with a higher risk of cancer in scleroderma. In contrast, the use of aspirin is related to a lower risk of cancer in our series. More studies are needed to ascertain the role of anti PM/Scl antibodies and aspirin in the development of malignancy among patients with SSc.
新出现的数据显示，系统性硬化症（SSc）患者的恶性肿瘤风险增加，因此识别两种疾病相关的危险因素可能具有预后意义。本研究旨在评估单中心队列 SSc 患者癌症的临床和治疗相关危险因素。
回顾性分析了 432 例连续 SSc 患者的人口统计学、临床、毛细血管镜、免疫学和治疗相关数据。单因素分析中达到显著相关性的变量被纳入逻辑回归，以确定癌症的独立危险因素。
53 例（12.2%）诊断为恶性肿瘤。共发现 58 种肿瘤，其中最常见的是乳腺癌（n=15）、肺癌（n=10）和血液系统肿瘤（n=9）。在 19 例患者中，硬皮病和肿瘤的诊断时间间隔<3 年。癌症显著降低了生存概率（OR=2.61；95%CI 1.46-4.69；p=0.001）。未发现与年龄、性别、吸烟、皮肤亚型或 RNA 聚合酶 III 抗体有关。然而，癌症风险与抗 PM/Scl 抗体的存在直接相关（OR=3.90；95%CI 1.31-11.61；p=0.014），与使用阿司匹林呈负相关（OR=0.33；95%CI 0.12-0.90；p=0.031），这两种因素在多因素分析中仍然是癌症的独立危险因素。
PM/Scl 抗体似乎与硬皮病患者的癌症风险增加有关。相反，在我们的研究中，阿司匹林的使用与癌症风险降低有关。需要更多的研究来确定抗 PM/Scl 抗体和阿司匹林在 SSc 患者恶性肿瘤发展中的作用。
