An International Cohort Study of Cancer in Systemic Lupus Erythematosus
An International Cohort Study of Cancer in Systemic Lupus Erythematosus
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DOI：
10.1002/art.21029
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发表时间：
2005-05-01
影响因子：
--
通讯作者：
Clarke, A
中科院分区：
文献类型：
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作者：
Bernatsky, S;Boivin, JF;Clarke, A
目标。越来越多的证据支持系统性红斑狼疮（SLE）与恶性肿瘤之间的关联，但在早期的研究中，这种关联无法精确量化。本研究旨在确定SLE患者的癌症发生率，并与一般人群进行比较。我们收集了一个多站点（23个中心）诊断为SLE的国际队列。每个中心的患者都与区域肿瘤登记处联系起来，以确定癌症的发生情况。标准化发病率（SIRs）计算为观察到的癌症与预期癌症的比率。通过将队列中的人年乘以地理上匹配的年龄、性别和日历年特定癌症发病率，并将所有人年相加，确定预期癌症。来自23个中心的9547例患者被观察了76948例患者年，平均随访8年。在观察期间，发生了431例癌症。数据证实SLE患者患癌症的风险增加。对于所有癌症，SIR估计值为1.15(95%可信区间[95% CI] 1.05-1.27)，对于所有血液恶性肿瘤，SIR估计值为2.75 (95% CI 2.13-3.49)，对于非霍奇金淋巴瘤，SIR估计值为3.64 （95% CI 2.63-4.93）。数据还显示肺癌（SIR 1.37; 95% CI 1.05-1.76）和肝胆癌（SIR 2.60; 95% CI 1.25, 4.78）的风险增加。这些结果支持SLE与癌症之间关联的概念，并更精确地定义SLE非霍奇金淋巴瘤的风险。目前尚不清楚这种关联是由遗传因素还是外源性暴露介导的。
Objective. There is increasing evidence in support of an association between systemic lupus erythematosus (SLE) and malignancy, but in earlier studies the association could not be quantified precisely. The present study was undertaken to ascertain the incidence of cancer in SLE patients, compared with that in the general population.Methods. We assembled a multisite (23 centers) international cohort of patients diagnosed as having SLE. Patients at each center were linked to regional tumor registries to determine cancer occurrence. Standardized incidence ratios (SIRs) were calculated as the ratio of observed to expected cancers. Cancers expected were determined by multiplying person-years in the cohort by the geographically matched age, sex, and calendar year-specific cancer rates, and summing over all person-years.Results. The 9,547 patients from 23 centers were observed for a total of 76,948 patient-years, with an average followup of 8 years. Within the observation interval, 431 cancers occurred. The data confirmed an increased risk of cancer among patients with SLE. For all cancers combined, the SIR estimate was 1.15 (95% confidence interval [95% CI] 1.05-1.27), for all hematologic malignancies, it was 2.75 (95% CI 2.13-3.49), and for non-Hodgkin's lymphoma, it was 3.64 (95% CI 2.63-4.93). The data also suggested an increased risk of lung cancer (SIR 1.37; 95% CI 1.05-1.76), and hepatobiliary cancer (SIR 2.60; 95% CI 1.25, 4.78).Conclusion. These results support the notion of an association between SLE and cancer and more precisely define the risk of non-Hodgkin's lymphoma in SLE. It is not yet known whether this association is mediated by genetic factors or exogenous exposures.