Prevalence, incidence, and risk factors of malignancy in patients with rheumatoid arthritis: a nationwide cohort study from Korea
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Background/Aims: This study aims to evaluate the incidence of malignancy in patients with rheumatoid arthritis (RA) and to investigate risk factors for such in a nationwide, population-based cohort. Methods: In a large, prospective, observational cohort study, 5,077 patients with RA were enrolled from July 2009 to December 2011 and followed until February 2017. Standardized incidence ratios (SIRs) for malignancy were calculated using age- and sex-specific cancer rates in the Korean general population. Poisson regression was used to identify the risk of incident malignancy. Results: The cohort included 5,023 participants with RA contributing 16,689 person-years of follow-up. A total of 148 malignancies were recorded. The risks of stomach cancer (SIR, 0.41; 95% confidence interval [CI], 0.21 to 0.74), colon cancer (SIR, 0.13; 95% CI, 0.03 to 0.37), and lung cancer (SIR, 0.35; 95% CI, 0.14 to 0.72) were lower in RA patients than in the general population. Poisson regression modeling demonstrated that the malignancy risk was more than two-fold greater in patients with thyroid disease than in those without thyroid disease. Hydroxychloroquine therapy was associated with a reduced risk (relative risk, 0.39; 95% CI, 0.189 to 0.801) of malignancy development. Conclusions: The overall risk of malignancy in patients with RA is decreased relative to in the general population. In particular, stomach, colon, and lung cancers in Korean RA patients are less common, while brain and central nervous system cancers in male RA patients are more frequent. The patients with thyroid disease and longer RA disease duration were at increased risk for developing malignancy, while hydroxychloroquine users were at lower risk.
Abstract
Background/Aims: This study aims to evaluate the incidence of malignancy in patients with rheumatoid arthritis (RA) and to investigate risk factors for such in a nationwide, population-based cohort. Methods: In a large, prospective, observational cohort study, 5,077 patients with RA were enrolled from July 2009 to December 2011 and followed until February 2017. Standardized incidence ratios (SIRs) for malignancy were calculated using age- and sex-specific cancer rates in the Korean general population. Poisson regression was used to identify the risk of incident malignancy. Results: The cohort included 5,023 participants with RA contributing 16,689 person-years of follow-up. A total of 148 malignancies were recorded. The risks of stomach cancer (SIR, 0.41; 95% confidence interval [CI], 0.21 to 0.74), colon cancer (SIR, 0.13; 95% CI, 0.03 to 0.37), and lung cancer (SIR, 0.35; 95% CI, 0.14 to 0.72) were lower in RA patients than in the general population. Poisson regression modeling demonstrated that the malignancy risk was more than two-fold greater in patients with thyroid disease than in those without thyroid disease. Hydroxychloroquine therapy was associated with a reduced risk (relative risk, 0.39; 95% CI, 0.189 to 0.801) of malignancy development. Conclusions: The overall risk of malignancy in patients with RA is decreased relative to in the general population. In particular, stomach, colon, and lung cancers in Korean RA patients are less common, while brain and central nervous system cancers in male RA patients are more frequent. The patients with thyroid disease and longer RA disease duration were at increased risk for developing malignancy, while hydroxychloroquine users were at lower risk.
참고문헌 (37)
- Smitten AL, "A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis", Arthritis Res Ther, 10, pp.R45~ (2008)
- Kauppi M, "Excess risk of lung cancer in patients with rheumatoid arthritis", J Rheumatol, 23, pp.1484~1485 (1996)
- Kauppi M, "Low incidence of colorectal cancer in patients with rheumatoid arthritis", Clin Exp Rheumatol, 14, pp.551~553 (1996)
- Simon TA, "Incidence of malignancy in adult patients with rheumatoid arthritis : a meta-analysis", Arthritis Res Ther, 17, pp.212~ (2015)
- Jin S, "Chinese registry of rheumatoid arthritis(CREDIT) : II. Prevalence and risk factors of major comorbidities in Chinese patients with rheumatoid arthritis", Arthritis Res Ther, 19, pp.251~ (2017)
- Gross RL, "A comparison of the malignancy incidence among patients with psoriatic arthritis and patients with rheumatoid arthritis in a large US cohort", Arthritis Rheumatol, 66, pp.1472~1481 (2014)
- Askling J, "How comparable are rates of malignancies in patients with rheumatoid arthritis across the world? A comparison of cancer rates, and means to optimise their comparability, in five RA registries", Ann Rheum Dis, 75, pp.1789~1796 (2016)
- Sung YK, "Korean Observational Study Network for Arthritis(KORONA) : establishment of a prospective multicenter cohort for rheumatoid arthritis in South Korea", Semin Arthritis Rheum, 41, pp.745~751 (2012)
- Arnett FC, "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis", Arthritis Rheum, 31, pp.315~324 (1988)
- "Cancer Registration Statistics" (2013)[URL]
- Huang WK, "No overall increased risk of cancer in patients with rheumatoid arthritis : a nationwide dynamic cohort study in Taiwan", Rheumatol Int, 34, pp.1379~1386 (2014)
- Kim YJ, "Mortality and incidence of malignancy in Korean patients with rheumatoid arthritis", J Rheumatol, 39, pp.226~232 (2012)
- Franklin J, "Influence of inflammatory polyarthritis on cancer incidence and survival : results from a community-based prospective study", Arthritis Rheum, 56, pp.790~798 (2007)
- Harigai M, "Risk for malignancy in rheumatoid arthritis patients treated with biological disease-modifying antirheumatic drugs compared to the general population : a nationwide cohort study in Japan", Mod Rheumatol, 26, pp.642~650 (2016)
- Cibere J, "Rheumatoid arthritis and the risk of malignancy", Arthritis Rheum, 40, pp.1580~1586 (1997)
- 이화정, "The Risk of Malignancy in Korean Patients with Rheumatoid Arthritis", Yonsei Medical Journal, 60(2), pp.223~229 (2019), 연세대학교의과대학[DOI]
- Hellgren K, "Rheumatoid arthritis and risk of malignant lymphoma : is the risk still increased?", Arthritis Rheumatol, 69, pp.700~708 (2017)
- Lim XR, "Incidence and patterns of malignancies in a multi-ethnic cohort of rheumatoid arthritis patients", Int J Rheum Dis, 22, pp.1679~1685 (2019)
- Parikh-Patel A, "Risk of cancer among rheumatoid arthritis patients in California", Cancer Causes Control, 20, pp.1001~1010 (2009)
- Yamada T, "Incidence of malignancy in Japanese patients with rheumatoid arthritis", Rheumatol Int, 31, pp.1487~1492 (2011)
- Jung HI, "Prevalence of lung cancer in patients with interstitial lung disease is higher than in those with chronic obstructive pulmonary disease", Medicine(Baltimore), 97, pp.e0071~ (2018)
- Naccache JM, "Lung cancer and interstitial lung disease : a literature review", J Thorac Dis, 10, pp.3829~3844 (2018)
- Gridley G, "Incidence of cancer among patients with rheumatoid arthritis", J Natl Cancer Inst, 85, pp.307~311 (1993)
- Tomic T, "Non-aspirin non-steroidal anti-inflammatory drugs in prevention of colorectal cancer in people aged 40 or older : a systematic review and meta-analysis", Cancer Epidemiol, 58, pp.52~62 (2019)
- Kong P, "The effects of anti-inflammatory drug treatment in gastric cancer prevention : an update of a meta-analysis", J Cancer, 7, pp.2247~2257 (2016)
- Hashimoto A, "Incidence of malignancy and the risk of lymphoma in Japanese patients with rheumatoid arthritis compared to the general population", J Rheumatol, 42, pp.564~571 (2015)
- Chen YJ, "The risk of cancer in patients with rheumatoid arthritis : a nationwide cohort study in Taiwan", Arthritis Rheum, 63, pp.352~358 (2011)
- Balakrishnan M, "Changing trends in stomach cancer throughout the world", Curr Gastroenterol Rep, 19, pp.36~ (2017)
- Peleteiro B, "Prevalence of Helicobacter pylori infection worldwide : a systematic review of studies with national coverage", Dig Dis Sci, 59, pp.1698~1709 (2014)
- Lim SH, "Trends in the seroprevalence of Helicobacter pylori infection and its putative eradication rate over 18 years in Korea : a cross-sectional nationwide multicenter study", PLoS One, 13, pp.e0204762~ (2018)
- Lee SJ, "The role of antimalarial agents in the treatment of SLE and lupus nephritis", Nat Rev Nephrol, 7, pp.718~729 (2011)
- Ruiz-Irastorza G, "Antimalarials may influence the risk of malignancy in systemic lupus erythematosus", Ann Rheum Dis, 66, pp.815~817 (2007)
- Bernatsky S, "Antimalarial drugs and malignancy : no evidence of a protective effect in rheumatoid arthritis", Ann Rheum Dis, 67, pp.277~278 (2008)
- Plantone D, "Current and future use of chloroquine and hydroxychloroquine in infectious, immune, neoplastic, and neurological diseases : a mini-review", Clin Drug Investig, 38, pp.653~671 (2018)
- Shi TT, "Research progress of hydroxychloroquine and autophagy inhibitors on cancer", Cancer Chemother Pharmacol, 79, pp.287~294 (2017)
- Li Q, "Increased risk of thyroid dysfunction among patients with rheumatoid arthritis", Front Endocrinol(Lausanne), 9, pp.799~ (2019)
- Weng CH, "Thyroid disorders and breast cancer risk in Asian population : a nationwide population-based case-control study in Taiwan", BMJ Open, 8, pp.e020194~ (2018)