系统性红斑狼疮住院患者的癌症发病情况：基于人群水平数据的关联研究。

Cancer development in patients hospitalized with systemic lupus erythematosus: A population-level data linkage study.

机构信息

Rheumatology Group, Medical School, University of Western Australia, Perth, Western Australia, Australia.

School of Population & Global Health, University of Western Australia, Perth, Western Australia, Australia.

出版信息

Int J Rheum Dis. 2023 Aug;26(8):1557-1570. doi: 10.1111/1756-185X.14784. Epub 2023 Jun 20.

DOI:10.1111/1756-185X.14784

PMID:37338061

Abstract

AIM

To explore the association between systemic lupus erythematosus (SLE) with the risk of cancer development and subsequent 5-year mortality in Western Australia (WA).

METHODS

Population-level, data linkage study of SLE patients (n = 2111) and general population comparators (n = 21 110) hospitalized between 1980 and 2014. SLE patients (identified by ICD-9-CM: 695.4, 710.0, and ICD-10-AM: L93.0, M32.0) were nearest matched (10:1) for age, sex, Aboriginality, and temporality. Follow up was from time zero (index SLE hospitalization) to cancer development, death or 31 December 2014. We assessed the risk of cancer development and subsequent 5-year mortality between SLE patients and comparators with univariate and multivariate-adjusted Cox proportional hazards regression models.

RESULTS

SLE patients had similar multivariate-adjusted risk (adjusted hazard ratio [aHR] 1.03, 95% confidence interval [CI] 0.93-1.15; p = .583) of cancer development. Cancer development risk was higher in SLE patients <40 years old (aHR 1.58, 95% CI 1.29-1.94; p < .001), and from 1980 to 1999 (aHR 1.16, 95% CI 1.02-1.31; p < .001). SLE patients had higher risk of developing cancer of the oropharynx (aHR 2.13, 95% CI 1.30-3.50), vulvo-vagina (aHR 3.22, 95% CI 1.34-7.75), skin (aHR 1.20, 95% CI 1.01-1.43), musculoskeletal tissues (aHR 2.26, 95% CI 1.16-4.40), and hematological tissues (aHR 1.78 95% CI 1.25-2.53), all p < .05. After cancer development, SLE patients had increased risk of 5-year mortality (aHR 1.31, 95% CI 1.06-1.61); highest in patients <50 years old (aHR 2.03, 95% CI 1.03-4.00), and in those with reproductive system and skin cancers.

CONCLUSIONS

Hospitalized SLE patients had increased risk of multiple cancer sub-types. Following cancer development, SLE patients had increased risk of 5-year mortality. There is scope to improve cancer prevention and surveillance in SLE patients.

TRIAL REGISTRATION

Not applicable. This low-risk risk study used de-identified administrative linked health data.

摘要

目的

探讨系统性红斑狼疮（SLE）与癌症发病风险和随后 5 年死亡率的关系在西澳大利亚州（WA）。

方法

对 1980 年至 2014 年间住院的 2111 例 SLE 患者（n=2111）和 21110 名普通人群对照者（n=21110）进行了人群水平、数据链接研究。SLE 患者（通过 ICD-9-CM：695.4、710.0 和 ICD-10-AM：L93.0、M32.0 识别）按年龄、性别、土著身份和时间最接近匹配（10:1）。随访时间从零时（指数 SLE 住院）开始至癌症发生、死亡或 2014 年 12 月 31 日。我们使用单变量和多变量调整 Cox 比例风险回归模型评估了 SLE 患者与对照者之间的癌症发病风险和随后 5 年的死亡率。

结果

SLE 患者的癌症发病风险相似（多变量调整后的危险比[aHR]1.03，95%置信区间[CI]0.93-1.15；p=0.583）。SLE 患者<40 岁（aHR 1.58，95%CI 1.29-1.94；p<0.001）和 1980 年至 1999 年（aHR 1.16，95%CI 1.02-1.31；p<0.001）的癌症发病风险较高。SLE 患者发生口咽癌（aHR 2.13，95%CI 1.30-3.50）、外阴阴道癌（aHR 3.22，95%CI 1.34-7.75）、皮肤癌（aHR 1.20，95%CI 1.01-1.43）、肌肉骨骼组织癌（aHR 2.26，95%CI 1.16-4.40）和血液组织癌（aHR 1.78，95%CI 1.25-2.53）的风险更高，所有 p<0.05。癌症发生后，SLE 患者 5 年死亡率的风险增加（aHR 1.31，95%CI 1.06-1.61）；<50 岁患者的风险最高（aHR 2.03，95%CI 1.03-4.00），以及生殖系统和皮肤癌患者。