Girma Blean, Farkas Dóra Körmendiné, Laugesen Kristina, Skajaa Nils, Henderson Victor W, Boffetta Paolo, Sørensen Henrik Toft
Department of Environmental Medicine and Public Health, Icahn School of Medicine, New York, NY, USA.
Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Clin Epidemiol. 2022 Jul 19;14:871-878. doi: 10.2147/CLEP.S369908. eCollection 2022.
It is unclear whether Guillain-Barré syndrome (GBS) can be a marker of a paraneoplastic syndrome. We examined whether GBS is associated with cancer and whether the prognosis of GBS patients with cancer differs from that of other cancer patients.
We conducted a population-based cohort study of patients diagnosed with GBS between 1978 and 2017 using Danish registry-data. Main outcome measures were cancer incidence and mortality after cancer diagnosis. We calculated absolute risks of a cancer diagnosis, treating death as competing risk, and standardized incidence ratios (SIRs) as measures of relative risk. We matched each GBS cancer patient with up to 10 cancer patients without a GBS diagnosis and examined the six-month survival after cancer diagnosis using Cox regression analysis.
We identified 7897 patients (58% male, median age 57 years) with GBS. During a median follow-up of 9.5 years, the one-year risk of cancer was 2.7% (95% confidence interval (CI), 2.4-3.1). The SIR was increased throughout follow-up, but most noticeably during the first year after diagnosis (SIR: 3.35, 2.92-3.83). SIRs were particularly elevated for hematologic cancers (SIR: 8.67, 6.49-11.34), smoking-related cancers (SIR: 3.57, 2.81-4.47), and cancers of neurological origin (SIR: 8.60, 5.01-13.77). Lung cancer was the main contributor to the overall excess risk, which persisted after 36 months of follow-up (SIR: 1.17, 1.09-1.25). The mortality rate ratio comparing patients diagnosed with any cancer within one year of their GBS diagnosis and matched GBS-free cancer cohort members was 1.56 (95% CI, 1.27-1.90).
GBS patients had a three-fold increased risk of cancer diagnosis in the first year of follow-up. The absolute cancer risk was almost 3.0%. A GBS diagnosis was an adverse prognostic marker for survival following cancer diagnosis. Clinicians should consider occult cancer in patients hospitalized with GBS.
吉兰 - 巴雷综合征（GBS）是否可能是副肿瘤综合征的一个标志物尚不清楚。我们研究了GBS是否与癌症相关，以及患有癌症的GBS患者的预后是否与其他癌症患者不同。
我们利用丹麦登记数据对1978年至2017年间诊断为GBS的患者进行了一项基于人群的队列研究。主要结局指标是癌症发病率和癌症诊断后的死亡率。我们将癌症诊断的绝对风险计算在内，将死亡视为竞争风险，并计算标准化发病率比（SIRs）作为相对风险的衡量指标。我们将每例GBS癌症患者与多达10例未诊断为GBS的癌症患者进行匹配，并使用Cox回归分析检查癌症诊断后的六个月生存率。
我们确定了7897例GBS患者（58%为男性，中位年龄57岁）。在中位随访9.5年期间，癌症的一年风险为2.7%（95%置信区间（CI），2.4 - 3.1）。在整个随访期间SIR均升高，但在诊断后的第一年最为明显（SIR：3.35，2.92 - 3.83）。血液系统癌症（SIR：8.67，6.49 - 11.34）、与吸烟相关的癌症（SIR：3.57，2.81 - 4.47）以及神经源性癌症（SIR：8.60，5.01 - 13.77）的SIRs尤其升高。肺癌是总体额外风险的主要贡献者，在随访36个月后该风险仍然存在（SIR：1.17，1.09 - 1.25）。将在GBS诊断后一年内诊断为任何癌症的患者与匹配的无GBS癌症队列成员进行比较，死亡率比为1.56（95%CI，1.27 - 1.90）。
GBS患者在随访的第一年癌症诊断风险增加了三倍。绝对癌症风险接近3.0%。GBS诊断是癌症诊断后生存的不良预后标志物。临床医生应考虑GBS住院患者存在隐匿性癌症的可能性。
