Gridley G, McLaughlin J K, Ekbom A, Klareskog L, Adami H O, Hacker D G, Hoover R, Fraumeni J F
Division of Cancer Etiology, National Cancer Institute, Rockville, Md.
J Natl Cancer Inst. 1993 Feb 17;85(4):307-11. doi: 10.1093/jnci/85.4.307.
To evaluate hypotheses about the relationship between immune alterations and cancer, several investigators have determined cancer incidence in groups of patients with rheumatoid arthritis (RA), a chronic autoimmune disease. The primary finding has been an increased risk of hematopoietic cancers.
In this study, we have attempted to refine estimates of the association between RA and subsequent development of specific cancers.
We investigated site-specific cancer risk associated with RA in a population-based cohort study of 11683 Swedish men and women with a hospital (inpatient) diagnosis of RA. These case patients were identified from 1965 to 1983 and had follow-up through 1984 by computer linkage of the Swedish Hospital Inpatient Register to the National Swedish Cancer Registry (840 case patients with cancer) and the Swedish Registry of Causes of Death. Cancer risk was estimated by standardized incidence ratios (SIRs) for specific cancers.
For men and women overall, there were decreased risks for cancers of the colon (SIR = 0.63; 95% confidence interval [CI] = 0.5-0.9), rectum (SIR = 0.72; 95% CI = 0.5-1.1), and stomach (SIR = 0.63; 95% CI = 0.5-0.9) and an increased risk for lymphomas (SIR = 1.98; 95% CI = 1.5-2.6).
The reduced risk for colorectal cancer in patients with RA is consistent with previous studies of RA patients and with reports which state that use of nonsteroidal anti-inflammatory drugs may protect against the development of large bowel cancers. The excess of lymphomas also confirms a number of earlier investigations of RA patients.
为了评估关于免疫改变与癌症之间关系的假说，一些研究人员确定了类风湿关节炎（RA）患者群体（一种慢性自身免疫性疾病）的癌症发病率。主要发现是造血系统癌症风险增加。
在本研究中，我们试图细化对RA与特定癌症后续发生之间关联的估计。
在一项基于人群的队列研究中，我们调查了11683名有医院（住院）诊断为RA的瑞典男性和女性与RA相关的特定部位癌症风险。这些病例患者于1965年至1983年被识别，并通过瑞典医院住院登记册与瑞典国家癌症登记册（840例癌症患者）以及瑞典死亡原因登记册的计算机链接随访至1984年。通过特定癌症的标准化发病比（SIR）估计癌症风险。
总体而言，男性和女性患结肠癌（SIR = 0.63；95%置信区间[CI] = 0.5 - 0.9）、直肠癌（SIR = 0.72；95% CI = 0.5 - 1.1）和胃癌（SIR = 0.63；95% CI = 0.5 - 0.9）的风险降低，患淋巴瘤的风险增加（SIR = 1.98；95% CI = 1.5 - 2.6）。
RA患者结直肠癌风险降低与先前对RA患者的研究以及使用非甾体抗炎药可能预防大肠癌发生的报告一致。淋巴瘤的增多也证实了对RA患者的一些早期调查结果。
