Department of Medicine, The University of Melbourne.
Department of Rheumatology, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Curr Opin Rheumatol. 2020 Nov;32(6):479-487. doi: 10.1097/BOR.0000000000000755.
As survival in systemic sclerosis (SSc) improves, research interest has shifted to the leading cause of non-SSc-related death, namely cancer, which accounts for over a third of non-SSc-related deaths. This review will provide an overview of the recent insights into the evolving relationship between SSc and cancer.
Recent studies confirm the increased risk of cancer in SSc compared with the general population (standardized incidence ratio 1.9-2.2) in particular the risk of breast, lung and skin cancer. This increased cancer risk, particularly occurring in close proximity to SSc onset, raises the novel concept of autoimmunity occurring as a direct immune response to the cancerous cells. We highlight the important role that SSc-specific autoantibodies may have in identifying these at-risk patients, prognostication and triaging those who may require tight surveillance and further cancer screening.
The knowledge will allow the development of future prospective studies evaluating clinically relevant and targeted cancer screening strategies for newly diagnosed SSc patients to optimize cancer detection while minimizing harms and costs from overscreening.
随着系统性硬化症（SSc）患者生存率的提高，研究重点已转移到 SSc 相关非致死性疾病的主要病因，即癌症，其在 SSc 相关非致死性疾病中占比超过三分之一。本综述将概述 SSc 和癌症之间关系的最新研究进展。
近期研究证实 SSc 患者罹患癌症的风险高于普通人群（标准化发病比为 1.9-2.2），尤其是乳腺癌、肺癌和皮肤癌。这种癌症风险的增加，特别是在 SSc 发病附近发生，提出了一个新的概念，即自身免疫是针对癌细胞的直接免疫反应。我们强调 SSc 特异性自身抗体在识别这些高危患者、预后判断以及对那些可能需要严格监测和进一步癌症筛查的患者进行分诊方面的重要作用。
这些知识将有助于制定未来的前瞻性研究，评估新诊断的 SSc 患者的临床相关和靶向癌症筛查策略，以优化癌症检测，同时最大限度地减少过度筛查的危害和成本。
