中国抗中性粒细胞胞浆抗体相关性血管炎患者恶性肿瘤发病率升高

IF 4.9 2区 医学 Q1 Medicine Arthritis Research & Therapy Pub Date : 2024-05-31 DOI:10.1186/s13075-024-03345-2
Xiang-Yu Han, Zhi-Ying Li, Ming-Hui Zhao, Mark A. Little, Min Chen
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引用次数: 0

摘要

据报道,在西方国家,与普通人群相比,抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)患者的恶性肿瘤风险更高。在本研究中,我们调查了中国 AAV 患者恶性肿瘤的发病率、发病谱和风险因素。研究招募了 1995 年至 2021 年期间在北京大学第一医院确诊并随访 12 个月以上的 AAV 患者。经性别、年龄和随访时间调整后,计算了恶性肿瘤的标准化发病率(SIR),以描述恶性肿瘤的风险。共招募了 552 例 AAV 患者,其中 23 例患者在确诊 AAV 之前或同时患有恶性肿瘤,其余 529 例患者中有 43 例在确诊 AAV 后 4.3 ± 4.2 年内发生恶性肿瘤(SIR:2.24;95% CI:1.68-2.99;P < 0.001)。在这 66 名患者中,发现了 20 种不同部位的恶性肿瘤,其中以肺癌最为常见。为了准确计算预期恶性肿瘤的 SIR,以下分析中纳入了 529 例无先发或并发恶性肿瘤的患者。肺癌仍然是最主要的恶性肿瘤诊断(SIR:5.01;95% CI:3.29-7.62),其次是肾脏、膀胱、输尿管和前列腺恶性肿瘤。男性性别(HR:2.84;95%CI:1.36-5.96;p = 0.006)和年龄(每年,HR:1.04;95%CI:1.00-1.07;p = 0.038)与恶性肿瘤风险的增加显著相关。对于在确诊AAV后5年后发生恶性肿瘤的患者,观察到累积环磷酰胺剂量超过20.0克的患者发生恶性肿瘤的风险明显更高(SIR:11.54;95% CI:4.77-27.93;p < 0.001)。在AAV确诊后的头两年内,恶性肿瘤的风险仍明显高于普通人群,但在这一亚组患者中,环磷酰胺的累积剂量与恶性肿瘤的发生并无明显关联。中国 AAV 患者的恶性肿瘤风险高于普通人群,其恶性肿瘤谱与西方国家不同。使用环磷酰胺和AAV本身都可能与恶性肿瘤发生率较高有关。
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Malignancy is increased in patients with antineutrophil cytoplasmic antibody-associated vasculitis in China
It has been reported that in western countries malignancy risk was higher in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) compared with that in the general population. In the current study, we investigated the incidence, spectrum and risk factors of malignancy in Chinese AAV patients. AAV patients diagnosed from 1995 to 2021 in Peking University First Hospital with a follow-up more than 12 months were recruited. Standardized incidence ratios (SIR) were calculated to describe the risk of malignancy, adjusted for sex, age and follow-up time. A total of 552 AAV patients were recruited, among which 23 patients had malignancies either preceding or concurrent with AAV diagnosis, and 43 of the remaining 529 patients developed malignancies within 4.3 ± 4.2 years post AAV diagnosis (SIR: 2.24; 95% CI: 1.68–2.99; p < 0.001). Among these 66 patients, twenty different sites of malignancy were observed, lung cancer being most frequent. To get exactly expected malignancies for the calculation of SIR, 529 patients without preceding or concurrent malignancies were included in the following analysis. Lung cancer was still the leading malignancy diagnosis (SIR: 5.01; 95% CI: 3.29–7.62), followed by malignancies in the kidney, bladder, ureter and prostate. Male gender (HR:2.84; 95%CI:1.36–5.96; p = 0.006) and older age (per year, HR:1.04; 95%CI:1.00-1.07; p = 0.038) were significantly associated with increased risk of malignancy. For patients with malignancy developed beyond 5 years after the diagnosis of AAV, a significantly higher malignancy risk was observed in those with a cumulative cyclophosphamide dose over 20.0 g (SIR: 11.54; 95% CI: 4.77–27.93; p < 0.001). Within the first 2 years after the diagnosis of AAV, the risk of malignancy was still significantly higher than that in the general population, but the cumulative cyclophosphamide dose was not significantly associated with malignancy occurrence in this subgroup of patients. Malignancy risk is higher in Chinese AAV patients than that in the general population, with a different malignancy spectrum from western countries. Both the use of cyclophosphamide and AAV per se might be associated with higher incidence of malignancy occurrence.
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来源期刊
CiteScore
8.60
自引率
2.00%
发文量
261
审稿时长
14 weeks
期刊介绍: Established in 1999, Arthritis Research and Therapy is an international, open access, peer-reviewed journal, publishing original articles in the area of musculoskeletal research and therapy as well as, reviews, commentaries and reports. A major focus of the journal is on the immunologic processes leading to inflammation, damage and repair as they relate to autoimmune rheumatic and musculoskeletal conditions, and which inform the translation of this knowledge into advances in clinical care. Original basic, translational and clinical research is considered for publication along with results of early and late phase therapeutic trials, especially as they pertain to the underpinning science that informs clinical observations in interventional studies.
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