Incidence of malignancy in patients treated for antineutrophil cytoplasm antibody-associated vasculitis: follow-up data from European Vasculitis Study Group clinical trials
Incidence of malignancy in patients treated for antineutrophil cytoplasm antibody-associated vasculitis: follow-up data from European Vasculitis Study Group clinical trials
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DOI：
10.1136/ard.2010.145250
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发表时间：
2011-08-01
影响因子：
27.4
通讯作者：
Mahr, A.
中科院分区：
文献类型：
--
作者：
Heijl, C.;Harper, L.;Mahr, A.
目的由于抗中性粒细胞胞浆抗体相关血管炎(AAV)(肉芽肿伴多血管炎(Wegener‘s)和显微镜下多血管炎(MPA))的标准免疫抑制治疗与癌症的发生密切相关，因此对接受治疗的AAV患者的癌症发病率进行了评估。在2004-2007年期间，研究参与者的后续事件被更新，包括被诊断为癌症。结果在2650人年的观察期内，46例患者共诊断出50例癌症。SIR(95%CI)为1.58(1.17~2.08)，非黑色素瘤皮肤癌(NMSC)为1.30(0.90~1.80)，膀胱癌为2.41(0.66~6.17)，白血病为3.23(0.39~11.65)，淋巴瘤为1.11(0.03~6.19)，NMSC为2.78(1.56~4.59)。GPA亚组SIR为1.92(1.31~2.71)，MPA亚组SIR为1.20(0.71~1.89)。这种癌症过剩在很大程度上是由NMSC发病率增加所致。与以前的研究相比，该队列中较小的癌症风险级别可能反映了当前治疗方案中环磷酰胺的广泛使用。需要更长的随访数据来评估在AAV过程中后期发生癌症的风险。
Objectives Because standard immunosuppressive treatment for antineutrophil cytoplasm antibody-associated vasculitis (AAV) (granulomatosis with polyangiitis (Wegener's) (GPA) and microscopic polyangiitis (MPA)) has been associated with a significant risk of developing cancer, the cancer incidence of treated AAV patients was assessed.Methods This analysis concerned 535 patients with newly diagnosed AAV from 15 countries who had been enrolled between 1995 and 2002 in four European clinical trials. Over the period 2004-7, study participants' follow-up events were updated, including cancers diagnosed. Age, sex and area-standardised incidence ratios (SIR) and their 95% CI were calculated by linkage to five national cancer databases.Results During the 2650 person-years' observation period, 50 cancers were diagnosed in 46 patients. SIR (95% CI) were 1.58 (1.17 to 2.08) for cancers at all sites, 1.30 (0.90 to 1.80) for cancers at all sites excluding non-melanoma skin cancer (NMSC), 2.41 (0.66 to 6.17) for bladder cancer, 3.23 (0.39 to 11.65) for leukaemia, 1.11 (0.03 to 6.19) for lymphoma and 2.78 (1.56 to 4.59) for NMSC. Subgroup SIR for cancers at all sites were 1.92 (1.31 to 2.71) for GPA and 1.20 (0.71 to 1.89) for MPA.Conclusions Cancer rates for AAV patients treated with conventional immunosuppressive therapy exceeded those expected for the general population. This cancer excess was largely driven by an increased incidence of NMSC. The smaller cancer risk magnitude in this cohort, compared with previous studies, might reflect less extensive use of cyclophosphamide in current treatment protocols. Longer follow-up data are warranted to appraise the risk of developing cancers later during the course of AAV.