Overall survival in patients with rheumatoid arthritis and solid malignancies receiving biologic disease-modifying antirheumatic therapy.
Overall survival in patients with rheumatoid arthritis and solid malignancies receiving biologic disease-modifying antirheumatic therapy.
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DOI：
10.1007/s10067-020-05318-7
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发表时间：
2020-10
影响因子：
3.4
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中科院分区：
文献类型：
--
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生物疾病缓解抗风湿药 (bDMARD) 对类风湿性关节炎 (RA) 和癌症患者的作用尚不清楚。我们检查了接受 bDMARD 治疗的 RA 和实体恶性肿瘤患者的总生存期 (OS)。我们对 2002 年至 2014 年间在 MD 安德森癌症中心就诊的 RA 和实体恶性肿瘤患者进行了一项回顾性队列研究。按肿瘤类型和分期分层的 Cox 比例风险回归模型适合评估 bDMARD 作为时间固定和时变协变量的使用。我们确定了 431 名患有实体恶性肿瘤的 RA 患者：其中 111 名 (26%) 在癌症诊断后接受了 bDMARD。癌症诊断后的中位 OS 为 16.1 年。在接受 bDMARD 的患者中，大多数患有局部疾病，只有 14 名 (13%) 患有晚期癌症。在分层 Cox 模型中，与未接受 bDMARD 治疗的患者相比，接受肿瘤坏死因子抑制剂 (TNFi) 治疗的患者或接受非 TNFi 治疗的患者之间没有观察到统计学上的显着差异（风险比 (HR)，0.67；95% 置信区间 (CI)，0.31，1.44；HR，1.10；95% CI，0.26，4.60）。在乳腺癌患者中，与未接受 bDMARD 的患者相比，接受 TNFi 或非 TNFi 治疗的患者的 HR 在数值上较高，但无统计学意义：HR 分别为 1.40（95% CI，0.42，4.73）和 HR，1.37（95% CI，0.22，8.42）。接受 bDMARD 治疗的患者与未接受 bDMARD 治疗的患者之间没有观察到 OS 存在显着差异。需要更多数据来评估其他癌症结果，例如复发和进展以及晚期癌症患者。
The effects of biologic disease-modifying anti-rheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) and cancer is largely unknown. We examined overall survival (OS) in patients with RA and solid malignancies receiving bDMARDs. We performed a retrospective cohort study of patients with RA and solid malignancies seen at MD Anderson Cancer Center between 2002 and 2014. Cox proportional hazard regression models, stratified by tumor type and stage, were fit evaluating use of bDMARDs as a time fixed, and time varying covariate. We identified 431 RA patients with solid malignancies: 111 (26%) received bDMARDs after their cancer diagnosis. Median OS from cancer diagnosis was 16.1 years. Of the patients receiving bDMARDs, most had localized disease, and only 14 (13%) had advanced cancer. In the stratified Cox models no statistically significant differences were observed between patients who received tumor necrosis factor inhibitors (TNFi) or patients who received non-TNFi, compared to those who did not receive bDMARDs (Hazard ratio (HR), 0.67; 95% confidence interval (CI), 0.31, 1.44; HR, 1.10; 95% CI, 0.26, 4.60 respectively). In breast cancer patients, those receiving TNFi or non-TNFi had a numerically higher but statistically non-significant HR compared to those who did not receive bDMARD: HR, 1.40 (95% CI, 0.42, 4.73), and HR, 1.37 (95% CI, 0.22, 8.42) respectively. No significant differences in OS were observed between patients who received bDMARDs and those who did not. Additional data is needed to evaluate other cancer outcomes such as recurrence and progression, and patients with advanced cancer.
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