Liver Diseases Research Center, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289 Jianguo Rd, Xindian Dist, New Taipei City, 23142, Taiwan, ROC.
School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
Hepatol Int. 2018 Nov;12(6):531-543. doi: 10.1007/s12072-018-9905-7. Epub 2018 Nov 14.
BACKGROUND/PURPOSE: Although rheumatoid arthritis (RA) has been linked to several important malignancies, data for the risks of hepatocellular carcinoma (HCC) in patients with RA are scarce. We aimed to examine the risk of HCC and cirrhosis-associated complications and the use of biologics in a national representative RA sample in Taiwan.
All study subjects aged ≥ 18 years in the Taiwan National Health Insurance program between January 1, 2000, and December 31, 2009 were enrolled. We matched RA and non-RA subjects by propensity scores in a 1:1 ratio. Our primary outcome was a diagnosis of HCC and cirrhosis-associated complications during a 10-year follow-up period. The risk of outcomes was represented as a hazard ratio (HR) calculated in Cox proportional hazard regression models.
24,245 RA and 24,245 non-RA subjects were included in the primary outcome analysis. Mean overall person-years (PY) of follow-up were 116,608 PY for the RA cohort, and 234,280 PY for the non-RA cohort. The overall incidence of HCC and cirrhosis-associated complications was lower in the RA cohort than in the non-RA cohort (0.66% vs. 1.41% HCC events and 1.45% vs. 1.95% cirrhosis-associated complications events during 10-year follow-up). The HRs adjusted for age, sex, the frequency of medical visits, and CCI were 0.57 (0.46-0.71) for HCC and 0.67 (0.59-0.76) for HCC and cirrhosis-associated complications. Although immunomodulatory agents may alter the risk of malignancy, use of biologics did not increase HCC risk in RA patients.
RA is associated with a reduced risk of developing HCC and cirrhosis-associated complications.
ClinicalTrials.gov identifier NCT02880306.
背景/目的：类风湿关节炎（RA）与多种重要恶性肿瘤相关，但 RA 患者发生肝细胞癌（HCC）的风险数据有限。本研究旨在调查台湾全国代表性 RA 样本中 HCC 及肝硬化相关并发症的风险和生物制剂的使用情况。
所有 2000 年 1 月 1 日至 2009 年 12 月 31 日期间参加台湾全民健康保险计划且年龄≥18 岁的患者均纳入研究。采用倾向评分 1:1 匹配法匹配 RA 和非 RA 患者。主要结局为 10 年随访期间 HCC 和肝硬化相关并发症的诊断。采用 Cox 比例风险回归模型计算结局风险的风险比（HR）。
纳入主要结局分析的 RA 患者和非 RA 患者分别为 24245 例和 24245 例。RA 队列的平均总随访人年为 116608 人年，非 RA 队列为 234280 人年。RA 队列 HCC 和肝硬化相关并发症的总发生率低于非 RA 队列（10 年随访期间 HCC 发生率分别为 0.66%和 1.41%，肝硬化相关并发症发生率分别为 1.45%和 1.95%）。调整年龄、性别、就诊频率和Charlson 共病指数后，HCC 的 HR 为 0.57（0.46-0.71），HCC 和肝硬化相关并发症的 HR 为 0.67（0.59-0.76）。免疫调节剂可能改变恶性肿瘤的风险，但生物制剂的使用并未增加 RA 患者的 HCC 风险。
RA 与 HCC 和肝硬化相关并发症风险降低相关。
ClinicalTrials.gov 标识符 NCT02880306。
