紅斑性狼瘡病患的癌症風險與對死亡率之影響：單一醫學中心回顧性研究

Cancer risk in patient with systemic lupus erythematosus and the impact on mortality: A single center cohort study

背景：紅斑性狼瘡是一種侵犯多系統的慢性自體免疫疾病，其特徵是持續且反覆的發炎而導致器官功能受損，並可能與多種共病症相關，如心血管疾病和癌症。由於先前關於紅斑性狼瘡與癌症發生率之間關聯的研究結果不一致，且近年隨著治療進步，患者壽命逐漸延長，癌症發生率可能與過去文獻有所變化，因此需要進行新的分析。
方法：我們進行了一項單一醫學中心、回溯性世代研究，納入了1,820名SLE患者，評估這些患者從2006年到2022年的癌症發生率和死亡率，並將這些數據與臺灣一般人群的數據進行了比較。
結果：在本研究納入的1,820名紅斑性狼瘡患者中，有75人（佔4.1%）被診斷出患有至少一種惡性腫瘤。與一般人群相比，甲狀腺癌的潛在風險有增加的趨勢，而乳腺癌雖然是本研究族群中最常見的惡性腫瘤，但其發生率大約只有台灣一般人群的一半。然而，上述這些差異均未達到統計學上的顯著性。一個經年齡調整的泊松迴歸模型（Poisson regression model）顯示，癌症診斷與死亡率顯著增加，且具有獨立關聯性。
結論：我們的研究結果表明，紅斑性狼瘡患者中不同癌症類型的發生情況與一般人群有所不同，而且紅斑性狼瘡患者一旦被診斷有癌症，死亡率會比沒有癌症的紅斑性狼瘡患者為高，反映出在追蹤治療自體免疫疾病時，進行癌症篩查和共病症管理的重要性。

Background: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease characterized by persistent inflammation, which can result in organ damage and various comorbidities, including cardiovascular disease and cancer. Due to inconsistent findings in previous studies on the link between SLE and cancer incidence, an updated analysis is necessary, especially with advancements in treatment and increased patient longevity.
Methods: We conducted a retrospective, single-center cohort study involving 1,820 SLE patients at National Taiwan University Hospital. We evaluated cancer incidence and mortality rates from 2006 to 2022 and compared these with data from the general Taiwanese population.
Results: Among the 1,820 SLE patients included in the study, 75 individuals (4.1%) were diagnosed with at least one malignancy. Compared to the general population, thyroid cancer showed a potentially increased risk (p = 0.09127), while breast cancer, despite being the most common malignancy in our cohort, had an incidence rate that was approximately half. However, neither of these differences reached statistical significance. A Poisson regression model, adjusting for age, revealed that a cancer diagnosis was independently associated with a significantly increased risk of mortality.
Conclusion: Our findings indicate that the occurrence of different cancer types in SLE patients differs from that in the general population. The higher mortality rates among SLE patients with cancer emphasize the importance of prompt cancer screening and managing comorbidities.