Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Ramat Gan 5265601, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel.
Int J Environ Res Public Health. 2021 Jul 16;18(14):7595. doi: 10.3390/ijerph18147595.
The association between giant cell arteritis (GCA) and malignancies had been widely investigated with studies reporting conflicting results. Therefore, in this study, we aimed to investigate this association using a large nationwide electronic database.
This study was designed as a retrospective cohort study including GCA patients first diagnosed between 2002-2017 and age, sex and enrollment time-matched controls. Follow-up began at the date of first GCA-diagnosis and continued until first diagnosis of malignancy, death or end of study follow-up.
The study enrolled 7213 GCA patients and 32,987 age- and sex-matched controls. The mean age of GCA diagnosis was 72.3 (SD 9.9) years and 69.1% were women. During the follow-up period, 659 (9.1%) of GCA patients were diagnosed with solid malignancies and 144 (2.0%) were diagnosed with hematologic malignancies. In cox-multivariate-analysis the risk of solid- malignancies (HR = 1.12 [95%CI: 1.02-1.22]), specifically renal neoplasms (HR = 1.60 [95%CI: 1.15-2.23]) and sarcomas (HR = 2.14 [95%CI: 1.41-3.24]), and the risk of hematologic malignancies (HR = 2.02 [95%CI: 1.66-2.47]), specifically acute leukemias (HR = 1.81 [95%CI: 1.06-3.07]), chronic leukemias (HR = 1.82 [95%CI: 1.19-2.77]), Hodgkin's lymphomas (HR = 2.42 [95%CI: 1.12-5.20]), non-Hodgkin's-lymphomas (HR = 1.66: [95%CI 1.21-2.29]) and multiple myeloma(HR = 2.40 [95%CI: 1.63-3.53]) were significantly increased in GCA patients compared to controls. Older age at GCA-diagnosis (HR = 1.36 [95%CI: 1.25-1.47]), male-gender (HR = 1.46 [95%CI: 1.24-1.72]), smoking (HR = 1.25 [95%CI: 1.04-1.51]) and medium-high socioeconomic status (HR = 1.27 [95%CI: 1.07-1.50]) were independently associated with solid malignancy while age (HR = 1.47 [95%CI: 1.22-1.77]) and male-gender (HR = 1.61 [95%CI: 1.14-2.29]) alone were independently associated with hematologic- malignancies.
our study demonstrated higher incidence of hematologic and solid malignancies in GCA patients. Specifically, leukemia, lymphoma, multiple myeloma, kidney malignancies, and sarcomas. Age and male gender were independent risk factors for hematological malignancies among GCA patients, while for solid malignancies, smoking and SES were risk factors as well.
巨细胞动脉炎（GCA）与恶性肿瘤之间的关联已被广泛研究，研究结果相互矛盾。因此，在这项研究中，我们旨在使用大型全国性电子数据库来研究这种关联。
本研究设计为回顾性队列研究，包括 2002-2017 年首次诊断为 GCA 的患者和年龄、性别和登记时间匹配的对照组。随访从首次 GCA 诊断开始，持续到恶性肿瘤、死亡或研究随访结束。
本研究纳入了 7213 名 GCA 患者和 32987 名年龄和性别匹配的对照组。GCA 诊断的平均年龄为 72.3（SD 9.9）岁，69.1%为女性。在随访期间，659 名（9.1%）GCA 患者被诊断为实体恶性肿瘤，144 名（2.0%）被诊断为血液恶性肿瘤。在多变量 Cox 分析中，实体恶性肿瘤（HR = 1.12 [95%CI：1.02-1.22]）、特别是肾肿瘤（HR = 1.60 [95%CI：1.15-2.23]）和肉瘤（HR = 2.14 [95%CI：1.41-3.24]）、血液恶性肿瘤（HR = 2.02 [95%CI：1.66-2.47]）、特别是急性白血病（HR = 1.81 [95%CI：1.06-3.07]）、慢性白血病（HR = 1.82 [95%CI：1.19-2.77]）、霍奇金淋巴瘤（HR = 2.42 [95%CI：1.12-5.20]）、非霍奇金淋巴瘤（HR = 1.66：[95%CI 1.21-2.29]）和多发性骨髓瘤（HR = 2.40 [95%CI：1.63-3.53]）在 GCA 患者中明显高于对照组。GCA 诊断时年龄较大（HR = 1.36 [95%CI：1.25-1.47]）、男性（HR = 1.46 [95%CI：1.24-1.72]）、吸烟（HR = 1.25 [95%CI：1.04-1.51]）和中高社会经济地位（HR = 1.27 [95%CI：1.07-1.50]）与实体恶性肿瘤独立相关，而年龄（HR = 1.47 [95%CI：1.22-1.77]）和男性（HR = 1.61 [95%CI：1.14-2.29]）仅与血液恶性肿瘤独立相关。
我们的研究表明，GCA 患者的血液系统和实体恶性肿瘤发病率较高。具体而言，白血病、淋巴瘤、多发性骨髓瘤、肾脏恶性肿瘤和肉瘤。年龄和男性是 GCA 患者血液恶性肿瘤的独立危险因素，而对于实体恶性肿瘤，吸烟和社会经济地位也是危险因素。
