Sakr Lama, Hudson Marie, Wang Mianbo, Younanian Elie, Baron Murray, Bernatsky Sasha
Division of Respirology, Jewish General Hospital, Montréal, QC, Canada.
Department of Medicine, McGill University, Montréal, QC, Canada.
J Scleroderma Relat Disord. 2018 Oct;3(3):221-227. doi: 10.1177/2397198318766825. Epub 2018 Apr 10.
The literature supports an increased risk of malignancy in systemic sclerosis, including lung cancer. Our objective was to identify potential independent predictors of lung cancer risk in systemic sclerosis.
We used a cohort of 1560 systemic sclerosis patients from the Canadian Scleroderma Research Group, enrolled from 2004 and followed for a maximum of 11 years. Time to lung cancer was calculated from the onset of the first non-Raynaud's symptoms. Baseline demographic, clinical, and serological characteristics of patients with and without lung cancer were compared. Cox proportional hazards models were used to estimate the effects of demographic variables, exposure to smoking, disease duration, disease subset (diffuse vs limited), immunosuppressant drug exposure, and presence of interstitial lung disease on the risk of lung cancer.
Over the 5519 total person-years of follow-up, 18 SSc patients were diagnosed with lung cancer after cohort entry (3.2 cancers per 1000 person-years). In univariate comparisons, cancer cases were more likely to be male, to have a smoking history, and to have interstitial lung disease than non-cases. In multivariate analysis, interstitial lung disease was independently associated with the risk of lung cancer (hazard ratio: 2.95, 95% confidence interval: 1.10-7.87).
In addition to known demographic (male sex) and lifestyle risk factors (smoking), interstitial lung disease is an independent risk factor for lung cancer in systemic sclerosis. These results have implications for lung cancer screening in systemic sclerosis.
文献表明系统性硬化症（包括肺癌）患者发生恶性肿瘤的风险增加。我们的目的是确定系统性硬化症患者肺癌风险的潜在独立预测因素。
我们使用了来自加拿大硬皮病研究小组的1560例系统性硬化症患者队列，这些患者于2004年入组，随访时间最长为11年。从首次非雷诺现象症状出现开始计算肺癌发生时间。比较了患肺癌和未患肺癌患者的基线人口统计学、临床和血清学特征。使用Cox比例风险模型来估计人口统计学变量、吸烟暴露、疾病持续时间、疾病亚型（弥漫性与局限性）、免疫抑制药物暴露以及间质性肺疾病的存在对肺癌风险的影响。
在总共5519人年的随访中，18例系统性硬化症患者在队列入组后被诊断为肺癌（每1000人年有3.2例癌症）。在单变量比较中，癌症病例比非癌症病例更可能为男性、有吸烟史且患有间质性肺疾病。在多变量分析中，间质性肺疾病与肺癌风险独立相关（风险比：2.95，95%置信区间：1.10 - 7.87）。
除了已知的人口统计学（男性）和生活方式风险因素（吸烟）外，间质性肺疾病是系统性硬化症患者肺癌的独立风险因素。这些结果对系统性硬化症患者的肺癌筛查具有重要意义。
