From The Research Institute of the McGill University Health Centre, Montreal; Université de Laval, Service de rheumatologie, Quebec City, Quebec; Toronto Western Hospital, Toronto, Ontario; Dalhousie University and Capital Health, Halifax, Nova Scotia; University of Manitoba, Winnipeg, Manitoba; Division of Rheumatology, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada; Northwestern University Feinberg School of Medicine, Chicago, Illinois; Johns Hopkins University School of Medicine, Baltimore, Maryland; University of California at San Francisco, Department of Medicine, San Francisco, California; State University of New York-Downstate Medical Center, Brooklyn; The Feinstein Institute for Medical Research, Manhasset, New York; Therapeutic Radiology, Yale University, New Haven, Connecticut, USA; University of Birmingham, College of Medical and Dental Sciences, Birmingham; University College London, Faculty of Medicine, Department of Rheumatology, London, UK; Lund University Hospital, Lund, Sweden; The Hospital for Rheumatic Diseases, Hanyang University, Seoul, Korea.
S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Centre; R. Ramsey-Goldman, MD, MPH, Northwestern University Feinberg School of Medicine; M. Petri, MD, MPH, Johns Hopkins University School of Medicine; M.B. Urowitz, MD, Toronto Western Hospital; D.D. Gladman, MD, Toronto Western Hospital; P.R. Fortin, MD, MPH, Université de Laval, Service de rheumatologie; E.H. Yelin, PhD, MCP, University of California, Department of Medicine; E. Ginzler, MD, MPH, State University of New York-Downstate Medical Center; J.G. Hanly, MD, Dalhousie University and Capital Health; C. Peschken, MD, MSc, University of Manitoba; C. Gordon, MD, University of Birmingham, College of Medical and Dental Sciences; O. Nived, MD, PhD, Lund University Hospital; C. Aranow, MD, The Feinstein Institute for Medical Research; S.C. Bae, MD, PhD, MPH, The Hospital for Rheumatic Diseases, Hanyang University; D. Isenberg, MD, University College, Faculty of Medicine, Department of Rheumatology; A. Rahman, MB, ChB, PhD, University College, Faculty of Medicine, Department of Rheumatology; J.E. Hansen, MD, MS, Therapeutic Radiology, Yale University; Y. St. Pierre, MSc, The Research Institute of the McGill University Health Centre; A.E. Clarke, MD, MSc, Division of Rheumatology, Cumming School of Medicine.
J Rheumatol. 2018 Mar;45(3):393-396. doi: 10.3899/jrheum.170652. Epub 2018 Jan 15.
To assess lung cancer risk in systemic lupus erythematosus (SLE), relative to demographics, drug exposures, smoking, and disease activity.
We analyzed data from 14 SLE cohorts. We calculated adjusted HR estimates for lung cancer in SLE, relative to demographics, smoking, time-dependent medication exposures, and cumulative disease activity [mean adjusted SLE Disease Activity Index (SLEDAI) scores]. This project was approved by the ethics boards of all participating institutions, including the Institutional Review Board of the McGill University Health Centre. The ethics approval number for the Cancer Risk study is GEN-06-031.
Within these 14 SLE cohorts, 49 incident lung cancers occurred. Among lung cancer cases, 59.0% were in the highest SLEDAI quartile at baseline versus 40.8% of lung cancer-free SLE controls. The vast majority (84.2%) of SLE lung cancer cases were ever-smokers at baseline, versus 40.1% of those without lung cancer. In adjusted models, the principal factors associated with lung cancer were ever smoking (at cohort entry) and current age. Estimated adjusted effects of all drugs were relatively imprecise, but did not point toward any drug exposures as strong lung cancer risk factors.
We saw no clear evidence for drugs as a trigger for lung cancer risk in SLE, although drug risk estimates were relatively imprecise. Smoking may be the most significant modifiable lung cancer risk factor in SLE.
评估系统性红斑狼疮（SLE）患者的肺癌风险，与人口统计学、药物暴露、吸烟和疾病活动度有关。
我们分析了来自 14 个 SLE 队列的数据。我们计算了 SLE 患者肺癌的校正 HR 估计值，与人口统计学、吸烟、时间依赖性药物暴露和累积疾病活动度[平均调整后的 SLE 疾病活动指数（SLEDAI）评分]有关。该项目得到了所有参与机构伦理委员会的批准，包括麦吉尔大学健康中心机构审查委员会。癌症风险研究的伦理批准编号为 GEN-06-031。
在这 14 个 SLE 队列中，有 49 例肺癌新发病例。在肺癌病例中，59.0%在基线时处于 SLEDAI 四分位最高 quartile，而在无肺癌的 SLE 对照组中为 40.8%。绝大多数（84.2%）的 SLE 肺癌患者在基线时曾吸烟，而无肺癌的患者为 40.1%。在调整后的模型中，与肺癌相关的主要因素是曾吸烟（在队列入组时）和当前年龄。所有药物的估计调整效果都相对不精确，但没有任何药物暴露被认为是肺癌的强烈危险因素。
我们没有发现药物是 SLE 肺癌风险的明确触发因素的证据，尽管药物风险估计相对不精确。吸烟可能是 SLE 中最重要的可改变肺癌危险因素。
