Dedousis Demitrios, Vassiliou Anastasia N, Cao Shufen, Yammani Deepthi, Kyasaram Ravi K, Shanahan John, Keinath Melissa C, Zhang Annie L, Hsu Melinda L, Fu Pingfu, Dowlati Afshin
Department of Internal Medicine/Case Western Reserve University, UH Cleveland Medical Center, University Hospitals, Cleveland, Ohio.
Case Western Reserve University, Cleveland, Ohio.
JTO Clin Res Rep. 2022 Jul 5;3(9):100375. doi: 10.1016/j.jtocrr.2022.100375. eCollection 2022 Sep.
Autoimmune disease has both a predisposing and a protective effect toward malignancy. Though studies have investigated the risk of malignancy in patients with autoimmune disease, there is limited research on how autoimmunity affects survival.
This study compared survival in patients with lung cancer with and without autoimmune disease. Patients with lung cancer were culled from the Surveillance, Epidemiology, and End Results Medicare databases (2007-2014), and autoimmune diseases were identified using diagnosis codes.
The overall prevalence of investigated autoimmune diseases among the 112,445 patients was 22.7%. Overall survival (OS) ( < 0.0001) was longer and cancer-specific mortality (CSM) ( < 0.0001) reduced among patients with autoimmune disease. Median OS was 5 months higher. Improved OS and CSM were also apparent in disease stages 1, 3, and 4 in the NSCLC and SCLC subgroups ( < 0.0001) and across most specific autoimmune diseases. After adjusting for the effects of age, sex, race, disease stage, and chronic kidney disease, autoimmune disease was still predictive of higher OS (hazard ratio = 1.23, 95% confidence interval: 1.21-1.25, < 0.0001) and reduced CSM (hazard ratio = 1.16, 95% confidence interval: 1.14-1.18, < 0.0001).
The prevalence of rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematous was highly enriched compared with the general population. The improvement in OS and CSM was larger in NSCLC than in SCLC, suggesting a larger role for the immune system in NSCLC. Alternate explanations for the improved survival include lead time bias, better access to health care, and a survival or autoimmunity-inducing genetic factor.
自身免疫性疾病对恶性肿瘤既有易患作用，也有保护作用。尽管已有研究调查了自身免疫性疾病患者发生恶性肿瘤的风险，但关于自身免疫如何影响生存率的研究有限。
本研究比较了患有和未患有自身免疫性疾病的肺癌患者的生存率。从监测、流行病学和最终结果医疗保险数据库（2007 - 2014年）中筛选出肺癌患者，并使用诊断编码识别自身免疫性疾病。
在112445例患者中，所调查的自身免疫性疾病的总体患病率为22.7%。自身免疫性疾病患者的总生存期（OS）更长（<0.0001），癌症特异性死亡率（CSM）降低（<0.0001）。中位OS高出5个月。在非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）亚组的疾病1期、3期和4期（<0.0001）以及大多数特定自身免疫性疾病中，OS和CSM的改善也很明显。在调整了年龄、性别、种族、疾病分期和慢性肾病的影响后，自身免疫性疾病仍然是较高OS（风险比=1.23，95%置信区间：1.21 - 1.25，<0.0001）和降低CSM（风险比=1.16，95%置信区间：1.14 - 1.18，<0.0001）的预测因素。
与普通人群相比，类风湿性关节炎、炎症性肠病和系统性红斑狼疮的患病率显著更高。NSCLC中OS和CSM的改善比SCLC更大，表明免疫系统在NSCLC中起更大作用。生存改善的其他解释包括提前期偏倚、更好的医疗保健可及性以及生存或诱导自身免疫的遗传因素。
