Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Int J Cancer. 2022 Oct 15;151(8):1216-1227. doi: 10.1002/ijc.34140. Epub 2022 Jun 23.
Immunity may play a role in preventing cancer progression. We studied associations of immune-related conditions with cancer-specific mortality among older adults in the United States. We evaluated 1 229 443 patients diagnosed with 20 common cancer types (age 67-99, years 1993-2013) using Surveillance Epidemiology and End Results-Medicare data. With Medicare claims, we ascertained immune-related medical conditions diagnosed before cancer diagnosis (4 immunosuppressive conditions [n = 3380 affected cases], 32 autoimmune conditions [n = 155 766], 3 allergic conditions [n = 101 366]). For each cancer site, we estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for cancer-specific mortality associated with each condition, applying a Bonferroni cutoff for significance (P < 5.1 × 10 ). Bayesian metaanalysis methods were used to detect patterns across groups of conditions and cancers. We observed 21 associations with cancer-specific mortality at the Bonferroni threshold. Increased cancer-specific mortality was observed with rheumatoid arthritis for patients with melanoma (aHR 1.51, 95% CI 1.31-1.75) and breast cancer (1.24, 1.15-1.33)), and with hemolytic anemia for bladder cancer (2.54, 1.68-3.82). Significant inverse associations with cancer-specific mortality were observed for allergic rhinitis (range of aHRs: 0.84-0.94) and asthma (0.83-0.95) for cancers of the lung, breast, and prostate. Cancer-specific mortality was nominally elevated in patients with immunosuppressive conditions for eight cancer types (aHR range: 1.27-2.36; P-value range: 7.5 × 10 to 3.1 × 10 ) and was strongly associated with grouped immunosuppressive conditions using Bayesian metaanalyses methods. For older patients with several cancer types, certain immunosuppressive and autoimmune conditions were associated with increased cancer-specific mortality. In contrast, inverse associations with allergic conditions may reflect enhanced immune control of cancer.
免疫可能在预防癌症进展中发挥作用。我们研究了美国老年人中与癌症特异性死亡率相关的免疫相关疾病。我们使用监测、流行病学和最终结果-医疗保险数据评估了 1229443 名被诊断患有 20 种常见癌症类型的患者（年龄 67-99 岁，1993-2013 年）。使用医疗保险索赔，我们确定了癌症诊断前诊断的免疫相关医疗状况（4 种免疫抑制状况[n=3380 例受影响病例]，32 种自身免疫状况[n=155766]，3 种过敏状况[n=101366]）。对于每个癌症部位，我们估计了与每种状况相关的癌症特异性死亡率的调整后的危险比（aHR）和 95%置信区间（CI），应用 Bonferroni 截止值进行显著性检验（P<5.1×10）。贝叶斯荟萃分析方法用于检测各组状况和癌症之间的模式。我们在 Bonferroni 阈值下观察到与癌症特异性死亡率相关的 21 个关联。对于黑色素瘤（aHR 1.51，95%CI 1.31-1.75）和乳腺癌（1.24，1.15-1.33）的患者，类风湿关节炎与癌症特异性死亡率增加有关，对于膀胱癌（2.54，1.68-3.82），溶血性贫血也有显著的相关性。过敏性鼻炎（aHR 范围：0.84-0.94）和哮喘（0.83-0.95）与肺癌、乳腺癌和前列腺癌的癌症特异性死亡率呈显著负相关。对于八种癌症类型的患者，免疫抑制状况与癌症特异性死亡率升高有关（aHR 范围：1.27-2.36；P 值范围：7.5×10-3.1×10），并且使用贝叶斯荟萃分析方法与分组免疫抑制状况密切相关。对于患有多种癌症类型的老年患者，某些免疫抑制和自身免疫状况与癌症特异性死亡率增加相关。相比之下，与过敏状况的负相关可能反映了对癌症的增强免疫控制。
