Markedly Reduced Risk of Internal Malignancies in Patients With Vitiligo: A Nationwide Population-Based Cohort Study
Markedly Reduced Risk of Internal Malignancies in Patients With Vitiligo: A Nationwide Population-Based Cohort Study
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DOI：
10.1200/jco.18.01223
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发表时间：
2019-04-10
影响因子：
45.3
通讯作者：
Kim, Miri
中科院分区：
文献类型：
--
作者：
Bae, Jung Min;Chung, Kee Yang;Kim, Miri
目的最近的研究表明，白癜风的自身免疫对黑色素细胞以外的细胞产生影响，从而降低白癜风患者患黑色素瘤和非黑色素瘤皮肤癌的风险。然而，白癜风患者发生内部恶性肿瘤的风险尚未阐明。 患者和方法 我们利用 2007 年 1 月至 2016 年 12 月获得的韩国国民健康保险索赔数据库的数据进行了一项基于人群的回顾性队列研究。确定了所有 20 岁或以上的白癜风患者，他们在 2009 年至 2016 年期间至少与医生接触过两次，在此期间做出了主要诊断（白癜风组）。与同期年龄和性别的白癜风组（对照组）进行频率匹配后，随机选择对照组（每名白癜风患者两名）。结果共纳入101,078名白癜风患者和202,156名无白癜风对照者。白癜风组和对照组的内部恶性肿瘤发病率分别为每10万人年612.9例和708.9例。调整年龄、性别和合并症后，与无白癜风的对照组相比，白癜风患者的总体内部恶性肿瘤风险显着降低（风险比 [HR]，0.86；95% CI，0.82 至 0.89；P < .001）。对于器官特异性恶性肿瘤，白癜风患者患结肠癌和直肠癌（HR，0.62；95% CI，0.55至0.69；P < 0.001）、卵巢癌（HR，0.62；95% CI，0.46至0.83；P < 0.001）和肺癌（HR，0.75；P < 0.001）的风险显着降低。 95% CI，0.65 至 0.86；P < .001)。 结论 白癜风与整体内部恶性肿瘤风险降低相关。这些发现表明，包括白癜风在内的自身免疫性疾病可能为目标器官以外的癌症发展提供免疫监视。 (C) 2019 年美国临床肿瘤学会
PURPOSE Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated.PATIENTS AND METHODS We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained from January 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group).RESULTS A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95% CI, 0.82 to 0.89; P < .001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95% CI, 0.55 to 0.69; P < .001), ovary (HR, 0.62; 95% CI, 0.46 to 0.83; P < .001), and lung (HR, 0.75; 95% CI, 0.65 to 0.86; P < .001).CONCLUSION Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ. (C) 2019 by American Society of Clinical Oncology