儿童期起病的系统性红斑狼疮中的恶性肿瘤。

Malignancy in Pediatric-onset Systemic Lupus Erythematosus.

机构信息

From the Research Institute of the McGill University Health Centre, Montreal, Quebec; University of Calgary, Calgary, Alberta; The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto, Toronto; Children's Hospital of Eastern Ontario, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Duke University Medical Center, Durham, North Carolina; Seattle Children's Hospital, Seattle, Washington; Columbia University Medical Center, New York, New York; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Hackensack University Medical Center, Hackensack, New Jersey; University of Alabama at Birmingham, Birmingham, Alabama; University of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Riley Hospital for Children, Indianapolis, Indiana; University of California, San Francisco, San Francisco, California, USA.

S. Bernatsky, MD, PhD, Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, University of Calgary; O. Zahedi Niaki, MD, Research Institute of the McGill University Health Centre; J. Labrecque, MSc, Research Institute of the McGill University Health Centre; L.E. Schanberg, MD, Duke University Medical Center; E.D. Silverman, MD, The Hospital for Sick Children, Hospital for Sick Children Research Institute, University of Toronto; K. Hayward, MD, Seattle Children's Hospital; L. Imundo, MD, Columbia University Medical Center; H.I. Brunner, MD, MSc, MBA, Cincinnati Children's Hospital Medical Center; K.A. Haines, MD, Hackensack University Medical Center; R.Q. Cron, MD, PhD, University of Alabama at Birmingham; K. Oen, MD, University of Manitoba; L. Wagner-Weiner, MD, MS, University of Chicago; A.M. Rosenberg, BA, MD, University of Saskatchewan; K.M. O'Neil, MD, Riley Hospital for Children; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario; E. von Scheven, MD, University of California; L. Joseph, PhD, Research Institute of the McGill University Health Centre; J.L. Lee, BSc, Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, DrPH, Northwestern University Feinberg School of Medicine.

出版信息

J Rheumatol. 2017 Oct;44(10):1484-1486. doi: 10.3899/jrheum.170179. Epub 2017 Aug 1.

DOI:10.3899/jrheum.170179

PMID:28765255

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5657309/

Abstract

OBJECTIVE

To determine cancer incidence in a large pediatric-onset systemic lupus erythematosus (SLE) population.

METHODS

Data were examined from 12 pediatric SLE registries in North America. Patients were linked to their regional cancer registries to detect cancers observed after cohort entry, defined as date first seen in the clinic. The expected number of malignancies was obtained by multiplying the person-years in the cohort (defined from cohort entry to end of followup) by the geographically matched age-, sex-, and calendar year-specific cancer rates. The standardized incidence ratio (SIR; ratio of cancers observed to expected) was generated, with 95% CI.

RESULTS

A total of 1168 patients were identified from the registries. The mean age at cohort entry was 13 years (SD 3.3), and 83.7% of the subjects were female. The mean duration of followup was 7.6 years, resulting in a total observation period of 8839 years spanning the calendar period 1974-2009. During followup, fourteen invasive cancers occurred (1.6 cancers per 1000 person-yrs, SIR 4.13, 95% CI 2.26-6.93). Three of these were hematologic (all lymphomas), resulting in an SIR for hematologic cancers of 4.68 (95% CI 0.96-13.67). SIR were increased for both male and female patients, and across age groups.

CONCLUSION

Although cancer remains a relatively rare outcome in pediatric-onset SLE, our data do suggest an increase in cancer for patients followed an average of 7.6 years. About one-fifth of the cancers were hematologic. Longer followup, and study of drug effects and disease activity, is warranted.

摘要

目的

确定大型儿科发病系统性红斑狼疮（SLE）人群中的癌症发病率。

方法

对北美 12 个儿科 SLE 登记处的数据进行了检查。将患者与他们的区域癌症登记处联系起来，以检测队列入组后观察到的癌症，定义为首次在诊所看到的日期。通过将队列中的人年数（从队列入组到随访结束）乘以地理匹配的年龄、性别和日历年龄特定癌症率，得出恶性肿瘤的预期数量。生成标准化发病比（SIR；观察到的癌症与预期的癌症之比），并提供 95%置信区间。

结果

从登记处共确定了 1168 名患者。队列入组时的平均年龄为 13 岁（标准差 3.3），83.7%的患者为女性。平均随访时间为 7.6 年，总观察期为 8839 年，跨越了 1974 年至 2009 年的日历时间。在随访期间，发生了 14 例侵袭性癌症（每 1000 人年发生 1.6 例癌症，SIR 为 4.13，95%置信区间为 2.26-6.93）。其中 3 例为血液系统（均为淋巴瘤），导致血液系统癌症的 SIR 为 4.68（95%置信区间为 0.96-13.67）。男性和女性患者以及各年龄组的 SIR 均升高。