Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors.
Skin cancer, rheumatoid arthritis, and tumor necrosis factor inhibitors.
复制标题
皮肤癌、类风湿性关节炎和肿瘤坏死因子抑制剂。
作者：
E. Chakravarty;K. Michaud;F. Wolfe
目的
确定与骨关节炎（OA）患者相比，类风湿性关节炎（RA）患者大队列中报告的非黑色素瘤皮肤癌（NMSC）的发生率，并确定RA患者发生NMSC的风险因素。
方法
自1999年以来，通过半年一次的问卷调查收集了15，789例RA患者和3，639例OA患者的自我报告信息。生存分析用于确定RA和OA患者中NMSC的发生率。使用多变量考克斯比例风险模型估计NMSC发生的风险比（HR）。对RA患者进行了单独分析，以探讨免疫抑制药物的使用与NMSC发展之间的关系。
结果
RA和OA患者中报告的NMSC的粗（未校正）发生率分别为18.1和20.4/1000患者年。OA患者年龄较大，更可能是白人，并且既往NMSC的发病率较高。在多变量考克斯比例风险模型中，年龄、男性、高加索人种和入组数据库前的NMSC病史与NMSC风险增加相关。校正协变量后，RA与NMSC风险增加相关（HR 1.19，p = 0.042）。在RA患者中，NMSC的发生与单独使用泼尼松（HR 1.28，p = 0.014）和肿瘤坏死因子（TNF）抑制剂或合并使用甲氨蝶呤（HR 1.24，p = 0.89和HR 1.97，p = 0.001）有关，此外还有确定的风险因素，包括白皙皮肤、年龄、男性和既往NMSC病史。未发现甲氨蝶呤或来氟米特的使用与NMSC的发生之间存在关联（分别为HR 1.12，p = 0.471，HR 0.83，p = 0.173）。
结论
在这个大型的国家队列中，RA与NMSC发展风险增加相关。在RA患者中，使用TNF抑制剂和泼尼松与NMSC风险增加相关。
OBJECTIVE
To determine the rates of reported non-melanoma skin cancer (NMSC) in a large cohort of patients with rheumatoid arthritis (RA) in comparison to patients with osteoarthritis (OA) and to determine risk factors for the development of NMSC in patients with RA.
METHODS
Self-reported information from 15,789 patients with RA and 3,639 patients with OA were collected through semi-annual questionnaires since 1999. Survival analyses were used to determine incidence rates for NMSC among patients with RA and OA. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HR) for the development of NMSC. Separate analyses were performed for patients with RA to explore associations between use of immunosuppressive medication and development of NMSC.
RESULTS
The crude (unadjusted) incidence rate for reported NMSC among patients with RA and OA were 18.1 and 20.4 per 1000 patient years, respectively. OA patients were older, more likely to be Caucasian, and had higher past incidence of NMSC. Age, male sex, Caucasian race, and history of NMSC prior to entry into the database were associated with an increased risk of NMSC in multivariate Cox proportional hazard models. After adjustment for covariates, RA was associated with an increased risk of NMSC (HR 1.19, p = 0.042). Among RA patients, the development of NMSC was associated with use of prednisone (HR 1.28, p = 0.014) and tumor necrosis factor (TNF) inhibitors alone or with concomitant methotrexate (HR 1.24, p = 0.89 and HR 1.97, p = 0.001, respectively) in addition to established risk factors including fair skin, age, male sex, and previous history of NMSC. No association was found between use of methotrexate or leflunomide and development of NMSC (HR 1.12, p = 0.471, HR 0.83, p = 0.173, respectively).
CONCLUSION
In this large, national cohort, RA was associated with an increased risk for development of NMSC. Among patients with RA, use of TNF inhibitors and prednisone were associated with an increased risk of NMSC.
DOI：
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发表时间：
1999
期刊：
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.
影响因子：
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作者：
Oliveria,SA;Christos,PJ;Halpern,AC;Fine,JA;Barnhill,RL;Berwick,M
通讯作者：
Berwick,M