From the EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309 (C.P., E.L.), Rennes University; Clermont-Ferrand University Hospital Center (A.M., X.M.); Survey, Data Science and Assessment Division (C.L.B.-B., P.-J.B.), French National Cancer Institute-InCA, Boulogne-Billancourt; and NeuroDol U1107 (X.M.), Clermont Auvergne University, Clermont-Ferrand, France.
Neurology. 2024 Nov 12;103(9):e209885. doi: 10.1212/WNL.0000000000209885. Epub 2024 Oct 9.
Previous literature has been diverging on cancer risk in people with multiple sclerosis (PwMS). Therefore, this study compared the risk of cancer in PwMS and a matched sample from the French general population.
This 10-year nationwide retrospective matched cohort study (2012-2021) used data from the national French administrative health care database (99% coverage of the French population) to determine the time to the first incident cancer. PwMS were identified using their long-term disease (LTD) status, hospitalizations, and multiple sclerosis (MS)-specific drug reimbursements. The control population was matched 4:1 on age, sex, residence, insurance scheme, and cohort entry date. Participants were included if they had no history of cancer in the 3 years before inclusion. Patients with cancer were identified through LTD status, hospitalizations, chemotherapy, radiotherapy, or prostate cancer-specific drug reimbursements. Overall and cancer location-specific hazard ratios (HRs) for the first incident cancer were obtained from Fine and Gray models, and age- and sex-stratified estimates were reported. Participation in cancer screening through the 3 national programs (breast, colorectal, and cervical) were compared between groups.
Cancer incidence was 799 per 100,000 person-years (PYs) (n = 8,368) among the 140,649 PwMS and 736 per 100,000 PYs (n = 31,796) among the 562,596 matched controls (70.8% of women; follow-up: 7.6 ± 3.2 years). A small overall risk increase was observed for PwMS (HR 1.06, 95% CI 1.03-1.08), mostly in women (HR 1.08, 95% CI 1.05-1.11). Risk varied by cancer types and was lower for prostate (HR 0.80, 95% CI 0.73-0.88), breast (HR 0.91, 95% CI 0.86-0.95), and colorectal (HR 0.90, 95% CI 0.84-0.97) cancer and higher for bladder (HR 1.71, 95% CI 1.54-1.89), brain (HR 1.68, 95% CI 1.42-1.98), and cervical (HR 1.24, 95% CI 1.12-1.38) cancer in PwMS. Cancer risk was higher in PwMS younger than 55 years (HR 1.20, 95% CI 1.15-1.24) but decreased in PwMS aged 65 years and older (HR 0.89, 95% CI 0.85-0.94). This trend was found in all cancer locations. There were fewer PwMS getting screened than controls (all programs), with a particularly pronounced difference among those aged 65 years and older.
Cancer risk was slightly increased in PwMS, particularly for urogenital cancers, possibly due to surveillance bias. Risk fluctuated depending on age, perhaps due to varying generational screening practices (i.e., diagnosis neglect in the older PwMS) and risk factors.
先前的文献在多发性硬化症（MS）患者的癌症风险方面存在分歧。因此，本研究比较了 MS 患者和法国普通人群中匹配样本的癌症风险。
这是一项全国范围内的回顾性匹配队列研究（2012-2021 年），使用国家法国行政医疗保健数据库的数据（覆盖法国人口的 99%）来确定首次癌症发病的时间。使用 LTD 状态、住院和多发性硬化症（MS）特定药物报销来确定 MS 患者。对照组按年龄、性别、居住地、保险计划和队列入组日期 4:1 匹配。如果患者在入组前 3 年内没有癌症病史，则将其纳入研究。通过 LTD 状态、住院、化疗、放疗或前列腺癌特定药物报销来确定癌症患者。通过 Fine 和 Gray 模型获得首次癌症的总体和癌症部位特异性风险比（HR），并报告年龄和性别分层的估计值。比较两组之间通过 3 个国家计划（乳腺癌、结直肠癌和宫颈癌）进行的癌症筛查参与情况。
在 140649 名 MS 患者中，癌症发病率为每 100000 人年 799 例（n=8368），在 562596 名匹配对照中，癌症发病率为每 100000 人年 736 例（n=31796）（70.8%为女性；随访：7.6±3.2 年）。MS 患者的总体风险略有增加（HR 1.06，95%CI 1.03-1.08），主要在女性中（HR 1.08，95%CI 1.05-1.11）。风险因癌症类型而异，前列腺癌（HR 0.80，95%CI 0.73-0.88）、乳腺癌（HR 0.91，95%CI 0.86-0.95）和结直肠癌（HR 0.90，95%CI 0.84-0.97）的风险较低，膀胱癌（HR 1.71，95%CI 1.54-1.89）、脑癌（HR 1.68，95%CI 1.42-1.98）和宫颈癌（HR 1.24，95%CI 1.12-1.38）的风险较高。年龄小于 55 岁的 MS 患者癌症风险更高（HR 1.20，95%CI 1.15-1.24），但年龄在 65 岁及以上的 MS 患者癌症风险降低（HR 0.89，95%CI 0.85-0.94）。这种趋势在所有癌症部位都有发现。接受筛查的 MS 患者比对照组（所有计划）少，尤其是 65 岁及以上的患者。
MS 患者的癌症风险略有增加，特别是泌尿系统癌症，这可能是由于监测偏倚所致。风险随年龄波动，可能是由于不同代际的筛查实践（即老年 MS 患者的诊断忽视）和风险因素所致。
