GOTHENBURG, Sweden (EGMN) – Patients with cutaneous lupus erythematosus appear to have an elevated overall risk of cancer, especially nonmelanoma skin cancer, lung cancer, and non-Hodgkin’s lymphoma.

That’s the preliminary conclusion from a Swedish national cohort study involving 3,788 Swedes with cutaneous LE (CLE), each matched to three controls and followed for an average of 4.1 years, said Dr. Carina M. Grönhagen at the annual congress of the European Academy of Dermatology and Venereology.

The take-home message from this first-ever look at the cancer risk associated with CLE is that patients with this skin disease need to be followed regularly for the emergence of malignancy. And they need to receive a strong antismoking message.

“Many of these cancers are connected to smoking, and patients with CLE are known to be smokers to a higher degree than in a normal population,” observed Dr. Grönhagen, a dermatology resident at Danderyd Hospital and doctoral candidate in medical epidemiology at the Karolinska Institute, Stockholm.

She and her coworkers decided to look at cancer rates in patients with CLE because CLE is an autoimmune disease, and epidemiologic studies indicate other autoimmune diseases are associated with increased cancer risk.

The overall number of cases of cancer documented in the CLE group during the study period was 188, compared with an expected 112. This 67% increased incidence rate ratio remained significant after adjustment for comorbid SLE, which dropped the ratio only to 60%.

The greatest increase in cancer risk seen in the CLE cohort was for nonmelanoma skin cancer, with a 4.3-fold relative risk, compared with controls. The other strongest risk increases were the 2.9-fold increase in lung cancer, the 2.7-fold increase in non-Hodgkin’s lymphoma, and the 2.7-fold rise in buccal cancer.

Asked if she thinks the observed increase in cancer in association with CLE is caused by the skin disease itself, or instead perhaps the immunosuppressive therapies employed in its treatment, Dr. Grönhagen replied that the well-established high rate of smoking among CLE patients is probably a significant contributor. But the immunologic derangement inherent in CLE is also likely to play a role, especially with regard to the increase in nonmelanoma skin cancer.

Dr. Grönhagen said her presentation at the congress was an interim analysis. Assigning three controls per CLE patient is insufficient to draw ironclad conclusions. She reported that with her coworkers, she is in the process of comparing cancer rates in the CLE cohort to those in the entire Swedish population in order to generate standardized incidence rates rather than incidence rate ratios.

She declared having no relevant financial relationships.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

瑞典哥德堡(EGMN)——Carina M. Grönhagen博士在欧洲皮肤病性病学会2010年年会上报告称，瑞典一项全国性队列研究的初步结论为：皮肤型红斑狼疮(LE)患者罹患各种癌症的总风险可能会增加，尤其是非黑色素瘤皮肤癌、肺癌和非霍奇金淋巴瘤。

 

该研究纳入了3,788例患有皮肤型LE (CLE)的瑞典患者，并以1：3的比例配比对照者，平均随访时间为4.1年。研究期间CLE组出现的癌症病例总数为188例，而预计只有112例，即癌症发病率增加了67%。经合并症系统性红斑狼疮(SLE)因素校正之后，发病率仍然增加了60%，仍具有统计学意义。CLE队列中癌症发病风险增加最明显的是非黑色素瘤皮肤癌，较之对照者相对风险增加了4.3倍。其次是肺癌、非霍奇金淋巴瘤和口腔癌，相对风险分别增加了2.9倍、2.7倍和2.7倍。

 

经确诊的CLE患者中吸烟的比例较高很可能是一个重要的诱因，但CLE患者本身的免疫功能紊乱也可能起到了一定作用，尤其是在非黑色素瘤皮肤癌的发病风险增加方面。

 

本研究是首个评价CLE相关癌症风险的研究，它告诉我们需要对患有这种皮肤病的患者进行定期随访以观察是否出现了恶性肿瘤，还应强烈建议其远离香烟。此次Grönhagen博士报告的只是中期分析的结果。每1例CLE患者配比3例对照者尚不足以得出非常确切的结论。

 

Grönhagen博士声明无相关经济利益冲突。

 

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