北京大学学报(医学版) ›› 2018, Vol. 50 ›› Issue (6): 986-990. doi: 10.19723/j.issn.1671-167X.2018.06.008

• 论著 • 上一篇    下一篇

合并恶性肿瘤的类风湿关节炎74例

王玉华,张国华,张令令,罗俊丽,高兰,赵绵松()   

  1. 首都医科大学附属北京世纪坛医院风湿免疫科, 北京 100038
  • 收稿日期:2018-07-06 出版日期:2018-12-18 发布日期:2018-12-18
  • 通讯作者: 赵绵松 E-mail:zmsdoctor@163.com
  • 基金资助:
    北京市自然科学基金项目(7123220);首都医科大学科研培育基金(PYZ 2017039);首都医科大学基础-临床科研合作基金(13JL64)(13JL64)

Clinical characteristic of 74 cases of malignant tumor in rheumatoid arthritis

Yu-hua WANG,Guo-hua ZHANG,Ling-ling ZHANG,Jun-li LUO,Lan GAO,Mian-song ZHAO()   

  1. Department of Rheumatology and Immunology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2018-07-06 Online:2018-12-18 Published:2018-12-18
  • Contact: Mian-song ZHAO E-mail:zmsdoctor@163.com
  • Supported by:
    Supported by Beijing National Science Foundation(7123220);Capital Medical University Research and Cultivation Fund PYZ(PYZ 2017039);Capital Medical University Foundation-Clinical Research Cooperation Fund(13JL64)

摘要:

目的: 对合并恶性肿瘤的类风湿关节炎患者74例的临床特征进行分析。方法: 回顾总结首都医科大学附属北京世纪坛医院2011年1月至2017年6月住院治疗的1 562例类风湿关节炎患者,对其中74例类风湿关节炎合并恶性肿瘤的患者的一般情况、所患肿瘤类型、类风湿关节炎和肿瘤起病顺序、用药情况等进行分析。结果: 类风湿关节炎患者恶性肿瘤的发病率为4.16%,74例患者中女性53例,男性21例。类风湿关节炎发病时年龄(52.6 ± 17.8) 岁,肿瘤确诊时年龄(63.4±12.7)岁。类风湿关节炎起病时间早于恶性肿瘤者51例(51/74),时间间隔2~60年,平均(17.2±14.2)年;恶性肿瘤发病早于类风湿关节炎者16例(16/74),时间间隔1~21年,平均(6.2±5.9)年,其中10例为性激素相关的肿瘤;二者同时发病7例(7/74),两者发生时间间隔在1年以内,7例均为RA先诊断,年龄均在60岁以上,且均为消化道肿瘤。肿瘤类型以胃肠道肿瘤、乳腺癌和生殖系统肿瘤最常见;其次为呼吸系统肿瘤、泌尿系统肿瘤和血液系统肿瘤。结论: 类风湿关节炎患者合并恶性肿瘤的风险增加,病情活动、药物的使用、雌激素及吸烟等是可能的危险因素,因此所有类风湿关节炎患者在诊断时均要进行恶性肿瘤筛查,诊断后要进行恶性肿瘤监测。

关键词: 类风湿关节炎, 恶性肿瘤, 恶性肿瘤监测

Abstract:

Objective: To investigate the clinical characteristics of rheumatoid arthritis (RA) patients with malignant tumor.Methods:Retrospective summary was made of 1 562 in patients of RA from January 2011 to June 2017.In the study, 74 RA patients with malignant tumor were reviewed and analyzed, and the general conditions, tumor types, RA and tumor onset sequence, and the medication situation were analyzed.Results:The incidence of malignant tumor in the patients with rheumatoid arthritis in our center was 4.16 %. The 74 patients were complicated with malignant tumor, of whom 53 were female,and 21 male. The age of RA at presentation was (52.6±17.8) years. The average disease duration of malignant tumor was (63.4 ± 12.7) years. The onset time of rheumatoid arthritis was earlier than that of malignant tumors in 51 cases (51/74), with an average of (17.2±14.2) years between 2 and 60 years. The incidence of malignant tumor was earlier than that of rheumatoid arthritis in 16 cases (16/74), with an average of (6.2±5.9) years between 1 and 21 years, of which 10 cases were sex hormone related tumors. Seven cases (7/74) were diagnosed with RA at the same time, and the time interval between the two diseases was within 1 year. All the patients were over 60 years old with digestive tract tumors. All the 7 patients showed polyarthritis, significantly increased erythrocyte sedimentation rate and C-reactive protein, including 4 rheumatoid factor positive cases and 2 anti-CCP antibody positive cases. The effect of non-steroidal anti-inflammatory drugs and traditional drugs to improve the condition of the disease was poor in the 7 patients, and the condition was relieved after using low-dose glucocorticoids. Gastrointestinal tumors, breast and reproductive system tumors were the most common, followed by respiratory, urological and blood system tumors.Conclusion:The risk in patients of rheumatoid arthritis complicated with malignant tumor is higher than that of the general population. A variety of factors play an important role in cancer risk of RA, including disease activity, some estrogen metabolites, the use of drugs and so on. Therefore, all RA patients should be screened for malignant tumor during diagnosis, and malignant tumor surveillance is mandatory for all rheumatoid arthritis patients after diagnosis.

Key words: Rheumatoid arthritis, Malignant tumor, Malignant tumor surveillance

中图分类号: 

  • R593.22

表1

类风湿关节炎合并恶性肿瘤的主要资料"

Tumor site Case Tumor diagnosis age/years, x-±s RA diagnosis age/years, x-±s Smoking history, n Tumor onset before/
concurring with/after RA onset
Breast 17 61.6±12.8 59.6±10.4 0 8/0/9
Colorectal 10 64.3±12.7 58.8±19.6 5 4/0/6
Lung 9 73.3±10.1 52.0±21.9 3 0/0/9
Esophagus 5 63.2±7.3 45.2±9.4 1 0/1/4
Lymphoma 5 65.8±14.1 53.6±24.9 0 1/0/4
Prostate 4 73.3±3.4 69.5±7.5 2 1/1/2
Endometrium 3 38.3±27.0 53.3±12.7 0 1/0/2
Pancreas 3 69.3±5.5 62.7±7.1 1 0/2/1
Thyroid 3 44.7±1.5 26.7±3.8 0 0/0/3
Stomach 2 69.0±14.1 47.5±16.3 0 0/1/1
Liver 2 76.0±8.5 57.5±21.9 1 0/0/2
Ovary 2 49.0±12.7 22.0±14.1 0 0/0/2
Biliary duct 1 64 63 0 0/1/0
Cholecyst 1 59 59 0 0/1/0
Periampullar 1 57 32 0 0/0/1
Meninges 1 57 47 0 0/0/1
Glioblastoma 1 61 44 0 0/0/1
Cervical 1 50 37 0 0/0/1
Peritoneal 1 74 55 0 0/0/1
Kidney 1 59 53 0 0/0/1
Testis 1 31 41 1 1/0/0

表2

类风湿关节炎与肿瘤发生时间"

General information RA onset before tumor RA and tumor occured simultaneously RA onset after tumor
Number of cases 51 7 16
Male :female 14 :37 3 :4 4 :12
Time interval/years 17.2±14.2 0.5±0.3 6.2±5.9
Tumor types and case number Breast/lung 9, colorectal 6,
esophagus/lymphoma 4, thyroid 3, prostate/endometrium/liver/ovary 2, pancreas/stomach/periampul-
lar/meninges/glioblastoma/cer-vical/peritoneal 1
Pancreas 2, esophagus/prostate/
stomach/biliary duct/cholecyst 1
Breast 8, colorectal 4, lymphoma/
prostate/endometrium/testis 1
[1] Simon TA, Thompson A, Gandhi KK , et al. Incidence of malignancy in adult patients with rheumatoid arthritis: a meta-analysis[J]. Arthritis Res Ther, 2015,17:212.
doi: 10.1186/s13075-015-0728-9 pmid: 18433475
[2] Turesson C, Matteson EL . Malignancy as a comorbidity in rheumatic diseases[J]. Rheumatology (Oxford), 2013,52(1):5-14.
doi: 10.1093/rheumatology/kes189 pmid: 22829694
[3] Gridley G , McLaughlin JK, Ekbom A, et al. Incidence of cancer among patients with rheumatoid arthritis[J]. J Natl Cancer Inst, 1993,85(4):307-311.
doi: 10.1093/jnci/85.4.307 pmid: 8426374
[4] Askling J, Fored CM, Brandt L , et al. Risks of solid cancers in patients with rheumatoid arthritis and after treatment with tumor necrosis factor antagonists[J]. Ann Rheum Dis, 2005,64(10):1421-1426.
doi: 10.1136/ard.2004.033993 pmid: 1005157
[5] Smitten AL, Simon TA, Hochberg MC , et al. A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis[J]. Arthritis Res Ther, 2008,10(2):R45.
doi: 10.1186/ar2404 pmid: 18433475
[6] Parikh-Patel A, White RH, Allen M , et al. Risk of cancer among rheumatoid arthritis patients in California[J]. Cancer Causes Control, 2009,20(6):1001-1010.
doi: 10.1007/s10552-009-9298-y pmid: 19184473
[7] Raheel S, Crowson CS, Wright K , et al. Risk of Malignant neoplasm in patients with incident rheumatoid arthritis 1980 -2007 in relation to a comparator cohort: a population-based study [J/OL]. Int J Rheumatol, https: //www.hindawi.com/journals/ijr/2016/4609486/.
[8] Chen W, Zheng R, Baade PD , et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016,66(2):115-132.
doi: 10.3322/caac.21338 pmid: 26808342
[9] Ometto F, Fedeli U, Schievano E , et al. Cause-specific mortality in a large population-based cohort of patients with rheumatoid arthritis in Italy[J]. Clin Exp Rheumatol, 2018,36(4):636-642
pmid: 29533757
[10] Pedersen JK, Holst R, Primdahl J , et al. Mortality and its predictors in patients with rheumatoid arthritis: a Danish population-based inception cohort study[J]. Scand J Rheumatol, 2018,47(5):371-377.
doi: 10.1080/03009742.2017.1420223 pmid: 29741136
[11] Manger B, Schett G . Rheumatic paraneoplastic syndromes: a clin-ical link between malignancy and autoimmunity[J]. Clin Immunol, 2018,186:67-70.
doi: 10.1016/j.clim.2017.07.021 pmid: 28736272
[12] Wen J, Ouyang H, Yang R , et al. Malignancy dominated with rheumatic manifestations: a retrospective single-center analysis[J]. Sci Rep, 2018,8(1):1786.
doi: 10.1038/s41598-018-20167-w pmid: 5789019
[13] Wilton KM, Matteson EL . Malignancy incidence, management and prevention in patients with rheumatoid arthritis[J]. Rheumatol Ther, 2017,4(2):333-347.
doi: 10.1007/s40744-017-0064-4 pmid: 28508282
[14] Chiu YM, Lang HC, Lin HY , et al. Risk of tuberculosis, serious infection and lymphoma with disease-modifying biologic drugs in rheumatoid arthritis patients in Taiwan[J]. Int J Rheum Dis, 2014,17(3):9-19.
doi: 10.1111/1756-185X.12539 pmid: 25496045
[15] Harigai M, Nanki T, Koike R , et al. 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[J]. Mod Rheumatol, 2016,26(5):642-650.
doi: 10.3109/14397595.2016.1141740 pmid: 26873430
[16] Mercer LK, Askling J, Raaschou P , et al. Risk of invasive melanoma in patients with rheumatoid arthritis treated with biologics: results from a collaborative project of 11 European biologic registers[J]. Ann Rheum Dis, 2017,76(2):386-391.
doi: 10.1136/annrheumdis-2016-209285 pmid: 5284347
[17] Wadstr?m H, Frisell T, Askling J , et al. Malignant neoplasms in patients with rheumatoid arthritis treated with tumor necrosis factor inhibitors, tocilizumab, abatacept, or rituximab in clinical practice a nationwide cohort study from Sweden[J]. JAMA Intern Med, 2017,177(11):1605-1612.
doi: 10.1001/jamainternmed.2017.4332 pmid: 28975211
[18] Mercer LK, Galloway JB, Lunt M , et al. Risk of lymphoma in patients exposed to antitumour necrosis factor therapy: results from the British society for rheumatology biologics register for rheumatoid arthritis[J]. Ann Rheum Dis, 2017,76(3):497-503.
doi: 10.1136/annrheumdis-2016-209389 pmid: 24685910
[19] de La Forest Divonne M, Gottenberg JE, Salliot C . Safety of biologic DMARDs in RA patients in real life: a systematic literature review and meta-analyses of biologic registers[J]. Joint Bone Spine, 2017,84(2):133-140.
doi: 10.1016/j.jbspin.2016.02.028 pmid: 27341745
[20] Khan WA, Khan MW . Cancer morbidity in rheumatoid arthritis: role of estrogen metabolites [J/OL]. Biomed Res Int, https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3789363/.
[21] Joseph RM, Movahedi M, Dixon WG , et al. Smoking-related mortality in patients with early rheumatoid arthritis: a retrospective cohort study using the clinical practice research datalink[J]. Arthritis Care Res (Hoboken), 2016,68(11):1598-1606.
doi: 10.1002/acr.22882 pmid: 26990778
[1] 张璐,胡小红,陈澄,蔡月明,王庆文,赵金霞. 类风湿关节炎初治患者颈椎失稳情况及临床特征[J]. 北京大学学报(医学版), 2021, 53(6): 1049-1054.
[2] 罗靓,霍文岗,张钦,李春. 类风湿关节炎合并角膜溃疡的临床特点和相关因素分析[J]. 北京大学学报(医学版), 2021, 53(6): 1032-1036.
[3] 钟华,徐丽玲,白明欣,苏茵. 类风湿关节炎患者趋化因子CXCL9和CXCL10在骨侵蚀中的作用[J]. 北京大学学报(医学版), 2021, 53(6): 1026-1031.
[4] 娄雪,廖莉,李兴珺,王楠,刘爽,崔若玫,徐健. 类风湿关节炎患者外周血TWEAK基因启动子区甲基化状态及其表达[J]. 北京大学学报(医学版), 2021, 53(6): 1020-1025.
[5] 曹迪,王燕,王柳青,孙晓麟,黄妃,孟洋,任丽丽,张学武. 血浆Dickkopf-1在类风湿关节炎患者中的表达及其与外周血T细胞亚群的相关性[J]. 北京大学学报(医学版), 2021, 53(2): 255-260.
[6] 赵凯,常志芳,王志华,庞春艳,王永福. 基因沉默肽基精氨酸脱亚胺酶4的表达对胶原诱导关节炎小鼠肺间质病变的影响[J]. 北京大学学报(医学版), 2021, 53(2): 235-239.
[7] 钟剑球,曾沛英,王庆文. 类风湿关节炎合并淋巴水肿2例及文献回顾[J]. 北京大学学报(医学版), 2020, 52(6): 1157-1161.
[8] 张警丰,叶修玲,段萌,周小利,姚中强,赵金霞. 抗核抗体阳性类风湿关节炎的临床和实验室检查特点[J]. 北京大学学报(医学版), 2020, 52(6): 1023-1028.
[9] 唐果,龙丽,韩雅欣,彭清,刘佳君,尚华. 类风湿关节炎合并结核感染的临床特点及相关因素[J]. 北京大学学报(医学版), 2020, 52(6): 1029-1033.
[10] 张璐,胡小红,王庆文,蔡月明,赵金霞,刘湘源. 类风湿关节炎合并颈椎失稳的人群分布及临床特征[J]. 北京大学学报(医学版), 2020, 52(6): 1034-1039.
[11] 陈家丽,金月波,王一帆,张晓盈,李静,姚海红,何菁,李春. 老年发病类风湿关节炎的临床特征及其心血管疾病危险因素分析:一项大样本横断面临床研究[J]. 北京大学学报(医学版), 2020, 52(6): 1040-1047.
[12] 彭嘉婧,刘田. 类风湿关节炎合并色素沉着绒毛结节性滑膜炎1例及文献回顾[J]. 北京大学学报(医学版), 2020, 52(6): 1135-1139.
[13] 罗采南,李正芳,武丽君,陈海娟,杨春梅,徐文晖,刘小玲,唐薇,乔平,热娜·白合提亚. 类风湿关节炎不同分类标准的多中心临床比较[J]. 北京大学学报(医学版), 2020, 52(5): 897-901.
[14] 竺红,赵丽娟,周艳,陈瑶. 抗氨基甲酰化蛋白抗体在类风湿关节炎合并肺间质病变早期诊断中的价值[J]. 北京大学学报(医学版), 2019, 51(6): 1003-1007.
[15] 张晓英,靳家扬,何菁,甘雨舟,陈家丽,赵晓珍,刘佳佳,尤旭杰,李雪,郭建萍,李小峰,李静,李茹,栗占国. 类风湿关节炎患者风湿病家族史特征及临床意义[J]. 北京大学学报(医学版), 2019, 51(3): 439-444.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 田增民, 陈涛, Nanbert ZHONG, 李志超, 尹丰, 刘爽. 神经干细胞移植治疗遗传性小脑萎缩的临床研究(英文稿)[J]. 北京大学学报(医学版), 2009, 41(4): 456 -458 .
[2] 郭岩, 谢铮. 用一代人时间弥合差距——健康社会决定因素理论及其国际经验[J]. 北京大学学报(医学版), 2009, 41(2): 125 -128 .
[3] 成刚, 钱振华, 胡军. 艾滋病项目自愿咨询检测的技术效率分析[J]. 北京大学学报(医学版), 2009, 41(2): 135 -140 .
[4] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报(医学版), 2009, 41(2): 158 -161 .
[5] 袁惠燕, 张苑, 范田园. 离子交换型栓塞微球及其载平阳霉素的制备与性质研究[J]. 北京大学学报(医学版), 2009, 41(2): 217 -220 .
[6] 徐莉, 孟焕新, 张立, 陈智滨, 冯向辉, 释栋. 侵袭性牙周炎患者血清中抗牙龈卟啉单胞菌的IgG抗体水平的研究[J]. 北京大学学报(医学版), 2009, 41(1): 52 -55 .
[7] 董稳, 刘瑞昌, 刘克英, 关明, 杨旭东. 氯诺昔康和舒芬太尼用于颌面外科术后自控静脉镇痛的比较[J]. 北京大学学报(医学版), 2009, 41(1): 109 -111 .
[8] 祁琨, 邓芙蓉, 郭新彪. 纳米二氧化钛颗粒对人肺成纤维细胞缝隙连接通讯的影响[J]. 北京大学学报(医学版), 2009, 41(3): 297 -301 .
[9] 李宏亮*, 安卫红*, 赵扬玉, 朱曦. 妊娠合并高脂血症性胰腺炎行血液净化治疗1例[J]. 北京大学学报(医学版), 2009, 41(5): 599 -601 .
[10] 李伟军, 邢晓芳, 曲立科, 孟麟, 寿成超. PRL-3基因C104S位点突变体和CAAX缺失体的构建及表达[J]. 北京大学学报(医学版), 2009, 41(5): 516 -520 .