年龄较大和癌症病史与黑色素瘤患者自身免疫性疾病的关联：一项横断面研究。
Association of advanced age and cancer history with autoimmune disease in melanoma patients: a cross-sectional study.
机构信息
University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
Sema4, Mount Sinai Health System, Stamford, CT, USA.
出版信息
BMC Cancer. 2021 Dec 6;21(1):1300. doi: 10.1186/s12885-021-09001-1.
BACKGROUND
Immune-related adverse events (irAEs) are a major toxicity of immune checkpoint inhibitors. Studies have reported that pre-existing autoimmunity increases the risk of irAEs, but it remains unknown which clinical factors are linked to auto-immune disorders in cancer patients. This study aimed to evaluate if the prevalence of autoimmune diseases varied by specific cancer history and advanced age.
METHODS
Our cross-sectional medical record review consisted of 291,333 patients (age, ≥18 years) treated between 2000 and 2018. Patients were classified into four study groups (melanoma only, non-cutaneous solid cancer only, melanoma and non-cutaneous cancer, and no cancer history). Dependent variable was the presence of ≥1 autoimmune disorders based on 98 conditions using 317 ICD codes.
RESULTS
Non-cutaneous cancer, in the absence or presence of melanoma, was associated with a higher prevalence of autoimmunity (16.5, 95% CI 16.1-16.9; 20.0, 95% CI 18.3-21.7, respectively) compared to the rates in patients with melanoma only and those without cancer history (9.3, 95% CI 8.6-10.0; 6.2, 95% CI 6.1-6.3, respectively). Among patients with metastases at initial presentation, those in the melanoma and non-cutaneous cancer group had a prevalence of 24.0% (95% CI 20.1-27.9) compared to 19.1% (95% CI 17.2-21.0) in those without metastases. Multiple logistic regression demonstrated that patients > 75 years exhibited the highest odds of autoimmunity relative to other age groups, with age 18-34 as the referent (OR, 1.78, 95% CI 1.67-1.89).
CONCLUSIONS
Among patients with melanoma, the greatest prevalence of autoimmunity occurred with advanced age and a history of non-cutaneous cancer.
背景
免疫相关不良反应（irAEs）是免疫检查点抑制剂的主要毒性。研究报告称，预先存在的自身免疫会增加 irAEs 的风险，但尚不清楚癌症患者的哪些临床因素与自身免疫性疾病有关。本研究旨在评估自身免疫性疾病的患病率是否因特定的癌症史和高龄而有所不同。
方法
我们的回顾性病历研究包括 291333 名（年龄≥18 岁）于 2000 年至 2018 年期间接受治疗的患者。患者分为四个研究组（仅黑色素瘤、仅非皮肤实体瘤、黑色素瘤和非皮肤癌、无癌症史）。因 317 个 ICD 代码下的 98 种疾病将基于是否存在≥1 种自身免疫性疾病作为因变量。
结果
与仅患有黑色素瘤的患者和无癌症史的患者相比，非皮肤癌，无论是否存在黑色素瘤，自身免疫的患病率都更高（16.5%，95%CI16.1-16.9%；20.0%，95%CI18.3-21.7%）。在初次就诊时有转移的患者中，患有黑色素瘤和非皮肤癌的患者的患病率为 24.0%（95%CI20.1-27.9%），而无转移的患者的患病率为 19.1%（95%CI17.2-21.0%）。多因素逻辑回归表明，与其他年龄组相比，年龄＞75 岁的患者发生自身免疫的可能性最高，以 18-34 岁为参照（OR1.78，95%CI1.67-1.89）。
结论
在患有黑色素瘤的患者中，年龄较大且有非皮肤癌病史的患者自身免疫的患病率最高。
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