Am J Epidemiol. 2022 Jan 24;191(2):298-319. doi: 10.1093/aje/kwab119.
We aimed to determine the risk of incident cancer in autoimmune hepatitis (AIH) compared with the general population and siblings. AIH was defined by the presence of a medical diagnosis of AIH and results of examination of a liver biopsy specimen in a nationwide Swedish population-based cohort study. We identified 5,268 adults with AIH diagnosed during 1969-2016 and 22,996 matched, general population, reference individuals and 4,170 sibling comparators. Using Cox regression, hazard ratios were determined for any incident cancer, and subtypes were determined from the Swedish Cancer Register. During follow-up, a cancer diagnosis was made in 1,119 individuals with AIH (17.2 per 1,000 person-years) and 4,450 reference individuals (12.0 per 1,000 person-years). This corresponded to a hazard ratio of 1.53 (95% confidence interval: 1.42, 1.66). Cancer risk was highest in those with cirrhosis. There was a 29.18-fold increased risk of hepatocellular carcinoma (HCC) (95% confidence interval: 17.52, 48.61). The annual incidence risk of HCC in individuals with AIH who had cirrhosis was 1.1% per year. AIH was also linked to nonmelanoma skin cancer (hazard ratio (HR) = 2.69) and lymphoma (HR = 1.89). Sibling analyses yielded similar risk estimates for any cancer (HR = 1.84) and HCC (HR = 23.10). AIH is associated with an increased risk of any cancer, in particular, HCC and extrahepatic malignancies. The highest risk for cancer, especially HCC, is in patients with cirrhosis.
我们旨在确定自身免疫性肝炎 (AIH) 患者与普通人群和兄弟姐妹相比发生癌症的风险。AIH 是通过全国性瑞典人群队列研究中存在医学诊断 AIH 和肝活检标本检查结果来定义的。我们确定了 1969 年至 2016 年间诊断出的 5268 名成年人 AIH 患者和 22996 名匹配的普通人群、参考个体和 4170 名兄弟姐妹对照者。使用 Cox 回归，确定了任何癌症的风险比，并且从瑞典癌症登记处确定了癌症亚型。在随访期间，1119 名 AIH 患者（17.2 人/千人年）和 4450 名参考个体（12.0 人/千人年）被诊断出患有癌症，这相当于风险比为 1.53（95%置信区间：1.42，1.66）。在肝硬化患者中，癌症风险最高。肝细胞癌（HCC）的风险增加了 29.18 倍（95%置信区间：17.52，48.61）。患有肝硬化的 AIH 患者的 HCC 年发病率风险为 1.1%。AIH 还与非黑色素瘤皮肤癌（风险比（HR）=2.69）和淋巴瘤（HR=1.89）有关。同胞分析得出了任何癌症（HR=1.84）和 HCC（HR=23.10）的相似风险估计值。AIH 与任何癌症的风险增加相关，特别是 HCC 和肝外恶性肿瘤。患有肝硬化的患者发生癌症的风险最高，特别是 HCC。
