Pediatric Clinic, IRCCS Ospedale Maggiore Policlinico Sant'Orsola, Department of Medicine and Surgery, University of Bologna, Bologna, Italy.
Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy.
Autoimmun Rev. 2021 Sep;20(9):102882. doi: 10.1016/j.autrev.2021.102882. Epub 2021 Jul 3.
In many autoimmune rheumatic diseases, there is an increased risk of cancer compared to the general population. The link between autoimmunity and cancer is dynamic and bidirectional. Recent advances in terms of knowledge of biology, epidemiology, and long-term outcomes for the autoimmune rheumatic diseases have revealed several new connections between these two entities. Data suggest that chronic inflammation from the rheumatic diseases or their therapies may contribute to the onset and promotion of cancer. Conversely, antitumor immune responses may become cross-reactive with self-tissues resulting in the development of autoimmunity. In this review, we discuss about the potential mechanisms that link autoimmune rheumatic diseases and cancer and the association of malignancies with common autoimmune disorders. The increased incidence of malignancy in autoimmune rheumatic diseases has been largely described, although the biology underpinning this relationship should be further investigated. The development of evidence-based cancer screening recommendations in patients with autoimmune rheumatic diseases is complex due to the heterogeneity of clinical rheumatic phenotypes, cancer sites at risk and exposure to anti-neoplastic and anti-rheumatic treatment. In order to lay the foundation of risk stratification and targeted cancer screening, larger longitudinal cohort studies that provide a more detailed framework of the links between cancer and autoimmunity are urgently needed.
在许多自身免疫性风湿病中，与普通人群相比，癌症的风险增加。自身免疫与癌症之间的联系是动态和双向的。近年来，随着对自身免疫性风湿病的生物学、流行病学和长期结局的了解不断深入，这两个实体之间出现了一些新的联系。有数据表明，风湿病或其治疗引起的慢性炎症可能导致癌症的发生和发展。相反，抗肿瘤免疫反应可能与自身组织发生交叉反应，从而导致自身免疫的发生。在这篇综述中，我们讨论了将自身免疫性风湿病与癌症联系起来的潜在机制，以及恶性肿瘤与常见自身免疫性疾病的关联。自身免疫性风湿病中恶性肿瘤发病率的增加已被广泛描述，尽管这种关系的生物学基础仍需进一步研究。由于临床风湿表型、风险部位的癌症、抗肿瘤和抗风湿治疗的异质性，为自身免疫性风湿病患者制定基于证据的癌症筛查建议非常复杂。为了为风险分层和有针对性的癌症筛查奠定基础，迫切需要进行更大的纵向队列研究，为癌症和自身免疫之间的联系提供更详细的框架。
