Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate
Incidence of melanoma and other malignancies among rheumatoid arthritis patients treated with methotrexate
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DOI：
10.1002/art.23716
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发表时间：
2008-06-15
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影响因子：
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通讯作者：
Jolley, Damien
中科院分区：
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作者：
Buchbinder, Rachelle;Barber, Melissa;Jolley, Damien
目标。目的：确定459例类风湿关节炎(RA)患者在社区实践中接受甲氨蝶呤治疗的癌症风险。所有在1986年6月之前开始使用甲氨蝶呤的类风湿性关节炎患者都接受了6位风湿科医生中的1位的治疗。人口统计数据与州癌症登记处匹配，以确定1983-1998年的所有恶性肿瘤(非黑色素瘤皮肤癌除外)，并与国家死亡指数匹配，以确定1999年底之前的所有死亡病例。随访开始于甲氨蝶呤开始的日期，结束于患者最后确认接受风湿科医生检查的日期或死亡。使用按性别、年龄(5岁组)和日历年分层的州人口癌症发病率计算标准化发病率比(SIRS)。随访4145人年，平均9.3年。共发现恶性肿瘤87例(前14例，中14例，后9例)。与一般人群相比，暴露于甲氨蝶呤的RA患者的恶性风险增加了50%(SIR 1.5，95%可信区间[95%CI]1.2-1.9)，黑色素瘤增加了3倍(SIR 3.0，95%CI 1.2-6.2)，非霍奇金淋巴瘤增加了5倍(SIR 5.1，95%CI 2.2-10.0)，肺癌增加了近3倍(SIR 2.9，95%CI 1.6-4.8)。与普通人群相比，接受甲氨蝶呤治疗的RA患者黑色素瘤、非霍奇金淋巴瘤和肺癌的发病率增加。对于所有RA患者，特别是那些接受免疫抑制治疗的患者，定期皮肤癌筛查可能会起到一定的作用。
Objective. To determine cancer risk in a cohort of 459 rheumatoid arthritis (RA) patients treated with methotrexate in community practice.Methods. All RA patients who started methotrexate prior to June 1986 and were attending 1 of 6 rheumatologists were studied. Demographic data were matched to the State Cancer Registry to identify all malignancies (except nonmelanoma skin cancer) for 1983-1998, and to the National Death Index to identify all deaths to the end of 1999. Followup started on the date when methotrexate was started and ended either on the last confirmed date on which the patient was seen by the rheumatologist or at death. Standardized incidence ratios (SIRs) were calculated using state population cancer rates stratified by sex, age (in 5-year groups), and calendar year.Results. There were 4,145 person-years of followup (average 9.3 years). Eighty-seven malignancies were identified (14 before, 64 during, and 9 after the followup period). There was an estimated 50% excess risk of malignancy among methotrexate-exposed RA patients relative to the general population (SIR 1.5, 95% confidence interval [95% CI] 1.2-1.9), with a 3-fold increase in melanoma (SIR 3.0, 95% CI 1.2-6.2), a 5-fold increase in non-Hodgkin's lymphoma (SIR 5.1, 95% CI 2.2-10.0), and an almost 3-fold increase in lung cancer (SIR 2.9, 95% CI 1.6-4.8).Conclusion. Compared with the general population, methotrexate-treated RA patients have an increased incidence of melanoma, non-Hodgkin's lymphoma, and lung cancer. There may be a role for regular skin cancer screening for all RA patients, particularly those receiving immunosuppressive therapy.