多发性硬化症、癌症风险与免疫抑制剂治疗之间的关联：一项队列研究。
Association between multiple sclerosis, cancer risk, and immunosuppressant treatment: a cohort study.
作者信息
Ragonese Paolo, Aridon Paolo, Vazzoler Giulia, Mazzola Maria Antonietta, Lo Re Vincenzina, Lo Re Marianna, Realmuto Sabrina, Alessi Simona, D'Amelio Marco, Savettieri Giovanni, Salemi Giuseppe
机构信息
Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (Department of Experimental Biomedicine and Clinical Neurosciences), Università degli Studi di Palermo, Via G. La Loggia, 1, 90129, Palermo, Italy.
出版信息
BMC Neurol. 2017 Aug 8;17(1):155. doi: 10.1186/s12883-017-0932-0.
BACKGROUND
The association between multiple sclerosis (MS) and cancer has long been investigated with conflicting results. Several reports suggest an increased cancer risk among MS patients treated with immunosuppressant (IS) drugs.
METHODS
We performed a cohort study including MS patients recruited at the Neurological Department of the University of Palermo. Mean follow-up period was ten years for the whole cohort. We calculated cancer incidence among patients treated with IS. Incidence rates were compared in the cohort by calculating the relative risk according to length and dose of exposure to IS. Cancer incidence among MS patients was compared to cancer incidence in the general population of Sicily in similar age groups.
RESULTS
On an overall cohort of 531 MS patients (346 women and 185 men) exposed to IS, we estimated a crude incidence rate for cancer of 2.26% (2.02% in women, 2.7% in men). Cancer risk was higher compared to rates observed among an equal number of patients not exposed to IS, and to the risk in the general population in Sicily at similar age groups (adjusted HR: 11.05; CI 1.67-73.3; p = 0.013).
CONCLUSION
The present study showed a higher cancer risk in MS patients associated only to previous IS exposure. Studies on long-term outcomes are essential to evaluate the possibility that treatment options that need to be considered for a long time-period may modify risk for life threatening diseases.
背景
长期以来，人们一直在研究多发性硬化症（MS）与癌症之间的关联，但结果相互矛盾。一些报告表明，接受免疫抑制剂（IS）治疗的MS患者患癌症的风险增加。
方法
我们进行了一项队列研究，纳入了在巴勒莫大学神经科招募的MS患者。整个队列的平均随访期为10年。我们计算了接受IS治疗的患者的癌症发病率。根据IS暴露的时长和剂量计算相对风险，对队列中的发病率进行比较。将MS患者的癌症发病率与西西里岛同年龄组普通人群的癌症发病率进行比较。
结果
在总共531名接受IS治疗的MS患者（346名女性和185名男性）队列中，我们估计癌症的粗发病率为2.26%（女性为2.02%，男性为2.7%）。与同等数量未接受IS治疗的患者的发病率以及西西里岛同年龄组普通人群的风险相比，癌症风险更高（调整后HR：11.05；CI 1.67 - 73.3；p = 0.013）。
结论
本研究表明，仅既往有IS暴露史的MS患者患癌症的风险更高。关于长期结局的研究对于评估长期需要考虑的治疗方案是否可能改变危及生命疾病的风险至关重要。
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