Rheumatology：类风湿关节炎患者整体肿瘤罹患风险高

吸烟、肿瘤病史、RA病程<3年及使用改变病情药物与肿瘤发生率相关

为了确定英国类风湿关节炎（RA）患者的肿瘤罹患风险，并对英国RA患者和一般人群的肿瘤罹患风险进行比较，及探讨该研究队列中肿瘤罹患的风险因素，来自英国曼彻斯特的英国关节炎研究中心、英国曼彻斯特大学的流行病学和曼彻斯特学术健康科技中心的Louise K. Mercer教授等人进行了一项研究，研究结果在线发布在2013年1月的《风湿病学》（Rheumatology）杂志上。研究发现，英国RA患者的总体肿瘤发病率高于一般人群。 研究对象符合以下条件：未接受生物制剂治疗或接受非生物制剂的及改变病情药物治疗的2002至2009年英国风湿病学会生物制品注册招募对象。研究者采用年龄、性别相关特异肿瘤发病率来计算英国人群的肿瘤标准化发病率（SIRS）。研究者依据英国总人口用泊松回归模型进行年龄、性别校准，使用校准后的泊松回归模型评估恶性肿瘤事件及其风险因素的关系。

研究结果如下，该研究共纳入3771位RA患者，共随访13315患者年。共报道182例癌症：156例实体肿瘤，26例髓系或淋巴系肿瘤。总体SIR是1.28（95% CI（95% 可信区间） 1.10, 1.48）。肺癌（SIR 2.39, 95% CI 1.75,3.19）、RA患者的霍杰金淋巴瘤（SIR 12.82, 95% CI 4.16, 29.92）和非霍杰金淋巴瘤(SIR 3.12, 95% CI 1.79, 5.07)罹患风险比一般人群高；而前列腺肿瘤（SIR 0.35, 95% CI 0.11, 0.82）和女性生殖器官肿瘤（SIR 0.35, 95% CI 0.10, 0.90）罹患风险比一般人群低。整个队列中，既往吸烟和目前正在吸烟的RA患者的肿瘤罹患风险比不吸烟的患者高2倍。

该项队列研究发现，英国RA患者的总体肿瘤发病率高于一般人群。在研究生物制剂如anti-TNF对肿瘤罹患风险影响时，需考虑RA本身与肿瘤的关系。

Risk of cancer in patients receiving non-biologic disease-modifying therapy for rheumatoid arthritis compared with the UK general population.

OBJECTIVES:

To quantify the risk of cancer and compare it with that for the general population in a modern cohort of UK patients with RA and to identify risk factors for cancer among this cohort.

METHODS:

The study population comprised biologic-naïve RA subjects receiving non-biologic disease-modifying therapy recruited to the British Society for Rheumatology Biologics Register from 2002 to 2009. Standardized incidence ratios (SIRs) for cancers were calculated using age- and gender-specific cancer rates in the English population. Poisson regression models adjusted for age and gender using England general population data were used to determine the association of other predictors with incident malignancy.

RESULTS:

The cohort comprised 3771 individuals with RA contributing 13 315 person-years of follow-up. One hundred and eighty-two cancers were reported: 156 solid and 26 myelo- or lymphoproliferative cancers. The overall SIR was 1.28 (95% CI 1.10, 1.48). Risks of lung cancer (SIR 2.39, 95% CI 1.75, 3.19), Hodgkin lymphoma (SIR 12.82, 95% CI 4.16, 29.92) and non-Hodgkin lymphoma (SIR 3.12, 95% CI 1.79, 5.07) were higher compared with the general population and risks of prostate cancer (SIR 0.35, 95% CI 0.11, 0.82) and cancers of the female genital organs (SIR 0.35, 95% CI 0.10, 0.90) were reduced. Within the cohort, cancer risk was more than 2-fold higher in current or ex-smokers than in non-smokers.

CONCLUSION:

The overall incidence of cancer was increased in this national cohort of subjects with RA. The association of RA with certain cancers needs to be considered when studying the effects of biologic therapy, such as anti-TNF, on cancer risk.