Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
JAMA Dermatol. 2018 Apr 1;154(4):435-440. doi: 10.1001/jamadermatol.2017.6334.
The association of pemphigus vulgaris and pemphigus foliaceus with comorbid malignancies is yet to be firmly established.
To estimate the association between pemphigus and a wide range of nonhematologic malignancies using one of the largest cohorts of patients with pemphigus to date.
DESIGN, SETTING, AND PARTICIPANTS: For this cross-sectional study, we used the computerized database of Clalit Health Services, the largest public health care provider organization in Israel insuring 4.4 million individuals in the settings of general community clinics, primary care and referral centers, and ambulatory and hospitalized health care. The study included 1985 patients with pemphigus and 9874 control patients and was conducted from January 2004 to December 2014.
The prevalence of 17 different solid malignancies was compared between patients diagnosed with pemphigus and age-, sex-, and ethnicity-matched control patients; χ2 and t tests were used for univariate analysis, and a logistic regression model was used for multivariate analysis. The association was examined following a sensitivity analysis that included only cases treated with long-term pemphigus-specific medications (corticosteroids, immunosuppressants, or rituximab), and following the adjustment for several confounding factors.
Overall, the total sample included 11 859 eligible patients, of whom 1985 were patients with pemphigus (mean [SD] age at presentation, 72.1 [18.5] years; 1188 women [59.8%]). In patients with pemphigus compared with control patients, there was a greater prevalence of esophageal cancers (0.4% vs 0.1%; odds ratio [OR], 2.9; 95% CI, 1.1-7.4) and laryngeal cancers (0.6% vs 0.3%; OR, 2.0; 95% CI, 1.0-4.1). No significant associations between pemphigus and other solid malignancies were observed. Estimates were not altered significantly after controlling for comorbidities, health care overutilization, immunosuppressive therapy, and other malignancy-specific risk factors (ie, smoking and alcohol abuse in laryngeal cancer, gastroesophageal reflux disease in esophageal cancer).
Significant associations were observed between pemphigus and solid malignancies of the larynx and the esophagus. Physicians treating patients with pemphigus should be aware of these findings. Further observational studies are warranted to establish this association in other cohorts.
天疱疮和类天疱疮与合并恶性肿瘤的关联尚未得到明确证实。
使用迄今为止最大的天疱疮患者队列之一，估计天疱疮与广泛的非血液恶性肿瘤之间的关联。
设计、设置和参与者：在这项横断面研究中，我们使用了 Clalit 健康服务的计算机数据库，这是以色列最大的公共医疗保健提供者组织，在普通社区诊所、初级保健和转诊中心、门诊和住院医疗保健机构中为 440 万人提供服务。该研究纳入了 1985 名天疱疮患者和 9874 名对照患者，研究时间为 2004 年 1 月至 2014 年 12 月。
比较了诊断为天疱疮的患者与年龄、性别和种族匹配的对照患者之间 17 种不同实体恶性肿瘤的患病率；使用 χ2 和 t 检验进行单变量分析，使用逻辑回归模型进行多变量分析。在仅包括接受长期天疱疮特异性药物（皮质类固醇、免疫抑制剂或利妥昔单抗）治疗的病例的敏感性分析后，以及在调整了多种混杂因素后，对相关性进行了检查。
总体而言，共有 11859 名合格患者纳入了该总样本，其中 1985 名患者患有天疱疮（就诊时的平均[SD]年龄，72.1[18.5]岁；女性 1188 名[59.8%]）。与对照患者相比，天疱疮患者中食管癌症（0.4%比 0.1%；比值比[OR]，2.9；95%CI，1.1-7.4）和喉癌（0.6%比 0.3%；OR，2.0；95%CI，1.0-4.1）的患病率更高。未观察到天疱疮与其他实体恶性肿瘤之间存在显著关联。在控制合并症、过度利用医疗保健、免疫抑制治疗和其他恶性肿瘤特异性风险因素（即喉癌中的吸烟和酗酒、食管癌中的胃食管反流病）后，估计值没有显著变化。
观察到天疱疮与喉和食管的实体恶性肿瘤之间存在显著关联。治疗天疱疮患者的医生应注意这些发现。需要进一步的观察性研究来在其他队列中确定这种关联。
