Phan Hiep, Weideman Rick A, Cipher Daisha J, Feagins Linda A
Department of Medicine, VA North Texas Healthcare System, Dallas, TX, USA.
Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Intest Res. 2020 Jul;18(3):282-288. doi: 10.5217/ir.2019.09140. Epub 2020 Apr 7.
BACKGROUND/AIMS: Safety for tumor necrosis factor inhibitors (TNFi) in cancer has been focused on risk of incident malignancies, but studies on prognostic effects have been scarce. We determined survival and recurrence rates at 1, 2, and 5 years after cancer diagnosis in patients with and without concurrent TNFi use.
Chart reviews were performed between 1996 and 2015 at the VA North Texas Healthcare System. Cases were patients with inflammatory disease, concomitant malignancy, and TNFi use while controls were patients with inflammatory disease, concomitant malignancy but no TNFi use. Cases and controls were matched for type of malignancy. Analysis was performed with log-rank tests on Kaplan-Meier curves.
Thirty-six cases and 72 controls were identified. For cases, survival at 1, 2, and 5 years were 32 (89%), 31 (86%), and 29 (81%) compared to 63 (90%), 61 (87%), and 51 (73%) for the control group (P=0.985). For cases, recurrence rates at 1, 2, and 5 years were 3 (8%), 5 (14%), and 6 (17%) compared to 2 (3%), 5 (7%), and 7 (10%) for the control group (P=0.158).
Our findings suggest TNFi may be safely used in select inflammatory disease patients with concurrent cancer if therapy is needed for proper disease control. However, case-by-case consideration in conjunction with an oncologist is recommended while considering the apparent safety of TNFi for patients suffering from active inflammatory diseases despite having a concomitant malignancy.
背景/目的：肿瘤坏死因子抑制剂（TNFi）在癌症治疗中的安全性一直聚焦于新发恶性肿瘤的风险，但关于其预后影响的研究却很匮乏。我们确定了在癌症诊断后1年、2年和5年时，使用和未使用TNFi的患者的生存率和复发率。
1996年至2015年期间，在北德克萨斯退伍军人医疗系统进行了病历回顾。病例组为患有炎症性疾病、合并恶性肿瘤且使用TNFi的患者，对照组为患有炎症性疾病、合并恶性肿瘤但未使用TNFi的患者。病例组和对照组按恶性肿瘤类型进行匹配。使用Kaplan-Meier曲线进行对数秩检验分析。
共确定了36例病例和72例对照。病例组1年、2年和5年的生存率分别为32例（89%）、31例（86%）和29例（81%），而对照组分别为63例（90%）、61例（87%）和51例（73%）（P = 0.985）。病例组1年、2年和5年的复发率分别为3例（8%）、5例（14%）和6例（17%），而对照组分别为2例（3%）、5例（7%）和7例（10%）（P = 0.158）。
我们的研究结果表明，如果需要进行适当的疾病控制治疗，TNFi可能可安全用于患有合并癌症的特定炎症性疾病患者。然而，尽管TNFi对患有活动性炎症性疾病且合并恶性肿瘤的患者具有明显安全性，但在考虑使用时，建议与肿瘤学家进行个案讨论。
