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作者：Simon et al. 翻译：李常虹 1 摘要背景 类风湿关节炎（RA）患者较普通人群发生肿瘤的风险增加。随着免疫调节治疗策略包括生物的改善病情抗风湿药的广泛使用，这尤其引起了人们对这部分人群的关注。我们进行了系统性文献回顾和分析，将RA患者和普通人群的肿瘤发生率进行了量化，并对既往发表的资料进行了更新。 2 方法 我们进行了一个类似2008年发表的荟萃分析相类似的文献搜索。我们使用特定的检索词在MEDLINE，BIOSIS Previews，Embase, Derwent Drug File和SciSearch数据库中进行了检索。根据预先确定的纳入标准选择了在2008年至2014年间发表的相关性观察性研究。提取有关整体肿瘤和部位特异性肿瘤发生风险相关的资料。计算出标准化发病比并与既往发表的数据进行比较。 3 结果 总共9项研究符合纳入标准，其中的7项研究给出了整体肿瘤的标准化发病比，8项研究给出了淋巴瘤、黑色素瘤和肺癌的标准化发病比，7项研究给出了前列腺癌的标准化发病比，4项研究给出了宫颈癌的标准化发病比。与普通人群的肿瘤发生情况相比，依据既往的观察发现RA患者的整体肿瘤标准化发病比适度增加。RA患者发生淋巴瘤和肺癌的风险要高于普通人群。此外，与普通人群相比，RA患者发生结肠癌和乳腺癌的风险更低，但发生宫颈癌、前列腺癌和黑色素瘤的风险未显示出一致性的趋势。 4 结论 本文中的其他附加资料与既往报道的数据基本一致。RA患者发生肺癌和淋巴瘤的风险较普通人群增高。定量比较使用生物制剂和非生物DMARDs药物治疗的RA患者之间肿瘤发生率的差异可进一步区分哪一种肿瘤发生与药物治疗有关而不是与潜在的疾病本身有关。 5 附原文 Abstract Introduction: Patients with rheumatoid arthritis (RA) are at an increased risk of malignancies compared with the general population. This has raised concerns regarding these patients, particularly with the widespread use of immunomodulating therapies, including biologic disease-modifying antirheumatic drugs (DMARDs). We performed a systematic literature review and analysis to quantify the incidence of malignancies in patients with RA and the general population to update previously published data.Methods: A literature search was conducted that was consistent with and similar to that in a meta-analysis published in 2008. MEDLINE, BIOSIS Previews, Embase, Derwent Drug File and SciSearch databases were searched using specified search terms. Predefined inclusion criteria identified the relevant observational studies published between 2008 and 2014 thatprovided estimates of relative risk of malignancy in patients with RA compared withthe general population. Risk data on overall malignancy and site-specific malignancies (lymphoma, melanoma and lung, colorectal, breast, cervical and prostate cancer) were extracted. The standardized incidence ratios (SIRs; a measure of risk) relative to the general population were evaluated and compared with published rates.Results: A total of nine publications met the inclusion criteria. Seven of these reported SIRs for overall malignancy; eight for lymphoma, melanoma, and lung, colorectal and breast cancer; seven for prostate cancer; and four for cervical cancer. Compared with those in the general population, the SIR estimates for patients with RA suggest a modest increased risk in overall malignancy, as previously observed. Patients with RA continued to show an increasedrisk of lymphoma and lung cancer compared with the general population. Overall, SIR estimates for colorectal and breast cancers continued to show a decrease in risk, whereas cervical cancer, prostate cancer and melanoma appeared to show no consistent trend in risk among patients with RA compared with the general population.Conclusions: The additional data evaluated here are consistent with previously reported data. Patients with RA are at an increased risk of lung and lymphoma malignancies compared with the general population. Quantifying differences in malignancy rates between non-biologic and biologic MARD-treated patients with RA may further highlight which malignancies may be related to treatment rather than to the underlying disease. 6 引自 Teresa A. Simon, Adam Thompson, Kunal K. Gandhi, Marc C. Hochberg and Samy Suissa. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis. Arthritis Research & Therapy (2015) 17:212 DOI 10.1186/s13075-015-0728-9 |
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