LONG-TERM NEOPLASIA RISK AFTER AZATHIOPRINE TREATMENT IN INFLAMMATORY BOWEL-DISEASE
LONG-TERM NEOPLASIA RISK AFTER AZATHIOPRINE TREATMENT IN INFLAMMATORY BOWEL-DISEASE
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DOI：
10.1016/s0140-6736(94)92150-4
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发表时间：
1994-05-21
期刊：
影响因子：
168.9
通讯作者：
LENNARDJONES, JE
中科院分区：
文献类型：
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作者：
CONNELL, WR;KAMM, MA;LENNARDJONES, JE
各种癌症的发病率，特别是非霍奇金淋巴瘤（NHL），在器官移植后接受硫唑嘌呤免疫抑制的患者中高于一般人群。我们研究了755例接受硫唑嘌呤治疗的炎症性肠病患者的肿瘤形成风险，这些患者在1962年至1991年期间接受了2 mg/kg/天的治疗，中位时间为12.5个月（范围为2天至15年）;中位随访时间为9年（范围为2周至29年）。总体而言，癌症没有显著过量：31例硫唑嘌呤治疗患者在85岁之前发生癌症，而一般人群中的预期发生率为24.3（观察/预期比值1.27，p=0.186）。结直肠癌（13例）和肛门癌（2例）的发生率存在差异（预期为2.27;比率为6.7，p=0.00001）;这些肿瘤被认为是慢性炎症性肠病的并发症。有2例浸润性宫颈癌（预期0.5），但无NHL病例。在广泛的慢性溃疡性结肠炎患者中，86名接受过硫唑嘌呤治疗的患者和180名从未接受过硫唑嘌呤治疗的匹配患者的癌症发生率没有差异。因此，硫唑嘌呤治疗不会显著增加炎症性肠病的癌症风险。
The incidence of various cancers, especially non-Hodgkin lymphoma (NHL), is higher among patients who receive azathioprine for immunosuppression after organ transplants than in the general population. We have studied the risk of neoplasia after azathioprine in 755 patients treated for inflammatory bowel disease.The patients received 2 mg/kg daily for a median of 12.5 months (range 2 days to 15 years) between 1962 and 1991; median follow-up was 9 years (range 2 weeks to 29 years). Overall there was no significant excess of cancer: 31 azathioprine-treated patients developed cancer before age 85 compared with 24.3 expected from rates in the general population (observed/expected ratio 1.27, p=0.186). There was a difference in the frequency of colorectal (13) and anal (2) carcinomas (expected 2.27; ratio 6.7, p=0.00001); these tumours are recognised complications of chronic inflammatory bowel disease. There were 2 cases of invasive cervical cancer (expected 0.5), but no case of NHL. Among patients with extensive chronic ulcerative colitis there was no difference in cancer frequency between 86 who had received azathioprine and 180 matched patients who had never received it.Thus, azathioprine treatment does not substantially increase the risk of cancer in inflammatory bowel disease.