Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
J Natl Cancer Inst. 2024 Feb 8;116(2):309-315. doi: 10.1093/jnci/djad187.
In the United States, anal squamous cell carcinoma rates have increased rapidly, particularly among women 50 or older than 66 years of age. As immunosuppression is associated with increased risk, autoimmune conditions may be associated with greater risk of anal squamous cell carcinoma.
We conducted a population-based, case-control study using Surveillance, Epidemiology, and End Results-Medicare data (2000-2017). Anal squamous cell carcinoma cases (n = 4505) were matched to 200 000 cancer-free controls. Using multivariable logistic regression, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) for associations between 47 autoimmune conditions diagnosed before selection, identified using Medicare claims, and anal squamous cell carcinoma. The Bonferroni threshold was used to correct for multiple comparisons. Population attributable fractions were calculated for conditions nominally associated with anal squamous cell carcinoma.
In total, 18% of anal squamous cell carcinoma cases and 15% of cancer-free controls had a diagnosed autoimmune condition. Any autoimmune condition was associated with an increased risk of anal squamous cell carcinoma (OR = 1.11, 95% CI = 1.02 to 1.21; population attributable fraction = 1.8%). Anal squamous cell carcinoma was associated with systemic lupus erythematosus (OR = 1.79, 95% CI = 1.32 to 2.42; population attributable fraction = 0.4%) and nominally associated (P < .05) with sarcoidosis (OR = 2.09, 95% CI = 1.30 to 3.37; population-attributable fraction = 0.2%) and psoriasis (OR = 1.28, 95% CI = 1.06 to 1.56; population attributable fraction = 0.5%). Stratified by sex, only women showed statistically significant associations for systemic lupus erythematosus (OR = 1.97, 95% CI = 1.46 to 2.68). Statistically significant interaction was observed by sex for psoriasis (men vs women: OR = 1.68 [95% CI = 1.03 to 4.28] vs OR = 1.12 [95% CI = 0.88 to 1.43]) and polymyalgia rheumatica (OR = 0.33 [95% CI = 0.12 to 0.89] vs OR = 0.99 [95% CI = 0.75 to 1.30]).
Systemic lupus erythematosus, sarcoidosis, and psoriasis were associated with a moderately increased risk of anal squamous cell carcinoma. Given these conditions' rarity and moderate associations with anal squamous cell carcinoma, autoimmune diseases cannot explain the rising trend in this disease.
在美国，肛门鳞状细胞癌的发病率迅速上升，尤其是在 50 岁或以上的女性中发病率高达 66 岁。由于免疫抑制与风险增加有关，自身免疫性疾病可能与肛门鳞状细胞癌的风险增加有关。
我们使用监测、流行病学和最终结果-医疗保险数据（2000-2017 年）进行了一项基于人群的病例对照研究。肛门鳞状细胞癌病例（n=4505）与 200000 例无癌症对照相匹配。使用多变量逻辑回归，我们计算了 47 种在选择前通过医疗保险索赔确定的自身免疫性疾病与肛门鳞状细胞癌之间的关联的优势比（OR）和 95%置信区间（CI）。采用 Bonferroni 阈值校正多重比较。计算名义上与肛门鳞状细胞癌相关的疾病的人群归因分数。
共有 18%的肛门鳞状细胞癌病例和 15%的无癌症对照者患有已确诊的自身免疫性疾病。任何自身免疫性疾病都与肛门鳞状细胞癌的风险增加有关（OR=1.11，95%CI=1.02 至 1.21；人群归因分数=1.8%）。肛门鳞状细胞癌与系统性红斑狼疮（OR=1.79，95%CI=1.32 至 2.42；人群归因分数=0.4%）相关，且与结节病（OR=2.09，95%CI=1.30 至 3.37；人群归因分数=0.2%）和银屑病（OR=1.28，95%CI=1.06 至 1.56；人群归因分数=0.5%）呈名义相关（P<0.05）。按性别分层，只有女性的系统性红斑狼疮（OR=1.97，95%CI=1.46 至 2.68）存在统计学显著关联。银屑病（男性与女性：OR=1.68[95%CI=1.03 至 4.28]与 OR=1.12[95%CI=0.88 至 1.43]）和多发性肌痛（OR=0.33[95%CI=0.12 至 0.89]与 OR=0.99[95%CI=0.75 至 1.30]）存在统计学显著性别交互作用。
系统性红斑狼疮、结节病和银屑病与肛门鳞状细胞癌的风险中度增加相关。鉴于这些疾病的罕见性和与肛门鳞状细胞癌的中度相关性，自身免疫性疾病不能解释这种疾病的上升趋势。
