To Sheng-Yin, Lee Cho-Hao, Chen Yi-Hsien, Hsu Li-Fan, Chen I-Wen, Yang Hui-Wen, Wen Yuan-Liang, Kao Li-Ting
Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
School of Pharmacy, National Defense Medical Center, Taipei, Taiwan.
JAMA Dermatol. 2025 Jul 2. doi: 10.1001/jamadermatol.2025.1949.
Autoimmune skin diseases (ASDs) and cancer both involve immune system dysregulation, with ASDs characterized by heightened immune activity, and cancer associated with immune evasion; however, their impact on cancer prognosis remains unclear.
To investigate the association of ASDs with cancer prognosis and survival outcomes after antineoplastic treatment in patients with cancer.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from Taiwan's Nationwide Cancer Registry and National Health Insurance Database to evaluate survival outcomes in patients with cancer who received antineoplastic treatment (ie, chemotherapy, targeted therapy, or immunotherapy) between January 1, 2019, and June 30, 2021. Data were analyzed from July 2023 to April 2025.
ASDs, including alopecia areata, Sjögren syndrome, vitiligo, cutaneous lupus erythematosus, psoriasis, lichen planus, autoimmune bullous diseases, systemic sclerosis, morphea, hidradenitis, and dermatomyositis.
All-cause mortality and cancer-specific mortality were assessed during the follow-up period. To account for potential confounding, both inverse probability of treatment weighting (IPTW) and propensity score matching strategies were applied. Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) for all-cause mortality, while the Fine-Gray hazard model was used to estimate subdistribution HRs (SHRs) for cancer-specific mortality, with noncancer-related deaths considered as competing events.
Of 197 895 patients included in the analysis, 26 008 were in the ASD group (mean [SD] age, 64.0 [13.3] years; 14 969 female [57.6%]) and 171 887 were in the non-ASD group (mean [SD] age, 62.8 [13.0] years; 80 525 female [46.9%]). Patients with ASDs had significantly better survival outcomes than those without ASDs, with an IPTW-adjusted HR of 0.94 (95% CI, 0.92-0.96) for all-cause mortality and an SHR of 0.94 (95% CI, 0.92-0.96) for cancer-specific mortality. These associations remained consistent in propensity score-matched analyses. Among ASD subtypes, alopecia areata and Sjögren syndrome were consistently associated with lower mortality risk.
This population-based cohort study found that patients with ASDs had significantly better cancer survival outcomes than those without ASDs. This finding suggests that there is a potential immunological association between ASDs and cancer prognoses, highlighting the need for further investigation into the underlying mechanisms and the implications for oncologic management.
自身免疫性皮肤病（ASD）和癌症均涉及免疫系统失调，ASD的特征是免疫活性增强，而癌症与免疫逃逸相关；然而，它们对癌症预后的影响仍不明确。
探讨ASD与癌症患者抗肿瘤治疗后的癌症预后及生存结局之间的关联。
设计、设置和参与者：这项基于人群的队列研究使用了来自台湾地区癌症登记处和国民健康保险数据库的数据，以评估2019年1月1日至2021年6月30日期间接受抗肿瘤治疗（即化疗、靶向治疗或免疫治疗）的癌症患者的生存结局。数据于2023年7月至2025年4月进行分析。
ASD，包括斑秃、干燥综合征、白癜风、皮肤红斑狼疮、银屑病、扁平苔藓、自身免疫性大疱性疾病、系统性硬化症、硬斑病、化脓性汗腺炎和皮肌炎。
在随访期间评估全因死亡率和癌症特异性死亡率。为了考虑潜在的混杂因素，同时应用了治疗权重逆概率（IPTW）和倾向评分匹配策略。应用Cox比例风险回归模型估计全因死亡率的风险比（HR），而使用Fine-Gray风险模型估计癌症特异性死亡率的亚分布风险比（SHR），将非癌症相关死亡视为竞争事件。
在纳入分析的197895例患者中，26008例属于ASD组（平均[标准差]年龄，64.0[13.3]岁；14969例为女性[57.6%]），171887例属于非ASD组（平均[标准差]年龄，62.8[13.0]岁；80525例为女性[46.9%]）。ASD患者的生存结局明显优于非ASD患者，全因死亡率的IPTW调整后HR为0.94（95%CI，0.92-0.96），癌症特异性死亡率的SHR为0.94（95%CI，0.92-0.96）。这些关联在倾向评分匹配分析中保持一致。在ASD亚型中，斑秃和干燥综合征始终与较低的死亡风险相关。
这项基于人群的队列研究发现，ASD患者的癌症生存结局明显优于非ASD患者。这一发现表明ASD与癌症预后之间存在潜在的免疫学关联，并突出了进一步研究潜在机制及其对肿瘤管理影响的必要性。
