National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
Rheumatology (Oxford). 2020 Dec 1;59(12):3817-3825. doi: 10.1093/rheumatology/keaa166.
Patients with osteoarthritis and ankylosing spondylitis have lower cancer-related mortality than the general population. We examined risks of solid cancers at 16 sites in elderly patients with knee or hip osteoarthritis (KHOA) or ankylosing spondylitis.
In this population-based retrospective cohort study, we used US Medicare data from 1999 to 2010 to identify cohorts of persons with KHOA or ankylosing spondylitis, and a general population group without either condition, who were followed through 2015. We compared cancer incidence among groups, adjusted for age, sex, race, socioeconomic characteristics, geographic region, smoking and comorbidities.
We studied 2 701 782 beneficiaries with KHOA, 13 044 beneficiaries with ankylosing spondylitis, and 10 859 304 beneficiaries in the general population group. Beneficiaries with KHOA had lower risks of cancer of the oropharynx, oesophagus, stomach, colon/rectum, hepatobiliary tract, pancreas, larynx, lung, and ovary than the general population. However, beneficiaries with KHOA had higher risks of melanoma, renal cell cancer, and cancer of the bladder, breast, uterus and prostate. Associations were similar in ankylosing spondylitis, with lower risks of cancer of the oesophagus, stomach, and lung, and higher risks of melanoma, renal cell cancer, and cancer of the renal pelvis/ureter, bladder, breast, and prostate.
Lower risks of highly prevalent cancers, including colorectal and lung cancer, may explain lower cancer-related mortality in patients with KHOA or ankylosing spondylitis. Similarities in cancer risks between KHOA and AS implicate a common risk factor, possibly chronic NSAID use.
骨关节炎和强直性脊柱炎患者的癌症相关死亡率低于普通人群。我们研究了老年膝或髋关节骨关节炎（KHOA）或强直性脊柱炎患者 16 个部位的实体癌风险。
在这项基于人群的回顾性队列研究中，我们使用了美国 1999 年至 2010 年的医疗保险数据，以确定 KHOA 或强直性脊柱炎患者队列，以及没有这两种疾病的一般人群队列，并随访至 2015 年。我们通过年龄、性别、种族、社会经济特征、地理区域、吸烟和合并症来调整癌症发病率在各组之间进行比较。
我们研究了 2701782 名 KHOA 受益人和 13044 名强直性脊柱炎受益人和 10859304 名一般人群受益人的情况。与一般人群相比，KHOA 患者患口咽癌、食管癌、胃癌、结肠癌/直肠癌、肝胆癌、胰腺癌、喉癌、肺癌和卵巢癌的风险较低。然而，KHOA 患者患黑素瘤、肾细胞癌和膀胱癌、乳腺癌、子宫癌和前列腺癌的风险较高。强直性脊柱炎的关联相似，其食管癌、胃癌和肺癌的风险较低，而黑素瘤、肾细胞癌和肾盂/输尿管癌、膀胱癌、乳腺癌和前列腺癌的风险较高。
包括结直肠癌和肺癌在内的高发癌症的风险较低，可能解释了 KHOA 或强直性脊柱炎患者癌症相关死亡率较低的原因。KHOA 和 AS 之间癌症风险的相似性暗示了一个共同的风险因素，可能是慢性 NSAID 的使用。
