老年强直性脊柱炎患者血液系统恶性肿瘤的风险：一项队列研究和系统评价。
Risk of Hematologic Malignancies in Elderly Patients With Ankylosing Spondylitis: A Cohort Study and Systematic Review.
机构信息
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD.
出版信息
Mayo Clin Proc. 2023 Jan;98(1):100-110. doi: 10.1016/j.mayocp.2022.06.030. Epub 2022 Dec 2.
OBJECTIVE
To examine the risk of hematologic malignancies in older adults with ankylosing spondylitis (AS).
PATIENTS AND METHODS
We used US Medicare data from January 1, 1999, to December 31, 2010, to identify a population-based cohort of beneficiaries with AS. We also included beneficiaries with inflammatory bowel disease (IBD) as disease controls and beneficiaries without AS or IBD as unaffected controls. We excluded those treated with tumor necrosis factor inhibitors in this period. We followed up each group for new diagnosis claims for hematologic malignancies until September 30, 2015.
RESULTS
We included 12,451 beneficiaries with AS, 234,905 with IBD, and 10,975,340 unaffected controls, with a mean follow-up of 9.9, 9.3, and 8.0 years, respectively. We identified 297 hematologic malignancies in the AS group, 4538 malignancies in the IBD group, and 128,239 malignancies in unaffected controls. The standardized incidence ratio in AS vs unaffected controls was 1.39 (95% CI, 1.05 to 1.61) for non-Hodgkin lymphoma, 1.50 (95% CI, 1.17 to 1.92) for chronic lymphocytic leukemia, and 1.52 (95% CI, 1.12 to 2.06) for multiple myeloma. Risks of acute myeloid leukemia and chronic myeloid leukemia were not elevated in AS, and there were too few cases of Hodgkin lymphoma to compute risks. Risks were comparable to those of beneficiaries with IBD. We also performed a systematic literature review of the risk of hematologic malignancy in AS, focusing on age associations, which have not been previously examined. We identified 21 studies in the systematic literature review, which included mainly young or middle-aged patients. Results suggested that AS was largely not associated with an increased risk of hematologic malignancies. Two cohort studies reported an increased risk of multiple myeloma in AS.
CONCLUSION
The risks of non-Hodgkin lymphoma, chronic lymphocytic leukemia, and multiple myeloma are increased among elderly patients with AS.
目的
研究强直性脊柱炎（AS）老年患者发生血液系统恶性肿瘤的风险。
方法
我们使用美国 1999 年 1 月 1 日至 2010 年 12 月 31 日的 Medicare 数据，确定了一个基于人群的 AS 患者队列。我们还纳入了患有炎症性肠病（IBD）的患者作为疾病对照，以及没有 AS 或 IBD 的患者作为未受影响的对照。在此期间，我们排除了接受肿瘤坏死因子抑制剂治疗的患者。我们对每个组进行新的血液系统恶性肿瘤诊断索赔的随访，直至 2015 年 9 月 30 日。
结果
我们纳入了 12451 名 AS 患者、234905 名 IBD 患者和 10975340 名未受影响的对照者，平均随访时间分别为 9.9、9.3 和 8.0 年。在 AS 组中，我们发现了 297 例血液系统恶性肿瘤，在 IBD 组中发现了 4538 例恶性肿瘤，在未受影响的对照组中发现了 128239 例恶性肿瘤。AS 与未受影响的对照组相比，非霍奇金淋巴瘤的标准化发病比为 1.39（95%CI，1.05-1.61），慢性淋巴细胞白血病为 1.50（95%CI，1.17-1.92），多发性骨髓瘤为 1.52（95%CI，1.12-2.06）。AS 患者的急性髓系白血病和慢性髓系白血病的风险并未升高，而霍奇金淋巴瘤的病例太少，无法计算风险。风险与 IBD 患者相当。我们还对 AS 中血液系统恶性肿瘤的风险进行了系统文献回顾，重点关注以前未研究过的年龄相关性。我们在系统文献回顾中确定了 21 项研究，主要纳入了年轻或中年患者。结果表明，AS 与血液系统恶性肿瘤的风险增加没有很大关系。两项队列研究报告称，AS 患者多发性骨髓瘤的风险增加。
结论
在老年 AS 患者中，非霍奇金淋巴瘤、慢性淋巴细胞白血病和多发性骨髓瘤的风险增加。
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