作者：Hellgren K, et al. 翻译：北医三院李常虹 摘要（瑞典、丹麦）背景：尚缺乏有关肿瘤坏死因子α抑制剂（TNFi）治疗脊柱关节炎（包括强直性脊柱炎、未分化脊柱关节炎）、银屑病关节炎后肿瘤风险方面的安全资料。本研究旨在评估使用TNFi治疗的脊柱关节炎患者与未使用TNFi治疗的脊柱关节炎和普通人群总体肿瘤发生风险之间的差异。

方法：我们在瑞典和丹麦生物制剂使用登记中心收集了共8703例在2001-2011年间首次使用TNFi的脊柱关节炎患者。我们从瑞典国家患者和人口登记中心收集了一个未使用过TNFi的人群队列（28164）和一个年龄性别相匹配的普通人群对照队列（131?687）。通过瑞典和丹麦国家肿瘤登记中心查询肿瘤发生情况，并计算性别/年龄标准发病率比值作为肿瘤发生的相对风险。

结果：以未使用TNFi治疗的脊柱关节炎患者中1188例罹患肿瘤为基准，整体肿瘤发生的相对风险为1.1。以使用TNFi治疗的脊柱关节炎患者中147例罹患肿瘤为基准，与未使用TNFi治疗的患者相比肿瘤发生的相对风险为0.8，与单独分析时强直性脊柱炎和银屑病关节炎患者结果类似。部位特异性肿瘤发生的相对风险分别为：前列腺0.5，肺0.6，结肠1.0，乳腺1.3，淋巴瘤0.8和黑色素瘤1.4。

结论：对于脊柱关节炎患者，使用TNFi治疗与肿瘤发生风险增加无关。TNFi既不增加整体肿瘤发生的风险，亦不增加6个常见部位肿瘤发生的风险。

附全文：Abstract BACKGROUND: Safety data on cancer risks following tumour necrosis factor α inhibitors (TNFi) in patients with spondyloarthritis (SpA) (here defined as ankylosing spondylitis (AS), undifferentiated spondarthropaties (SpA UNS), psoriatic arthritis (PsA)) are scarce. Our objective was to assess risks for cancer overall and for common subtypes in patients with SpA treated with TNFi compared with TNFi-na?ve patients with SpA and to the general population.METHODS: From the Swedish (Anti-Rheumatic Therapy in Sweden (ARTIS)) and Danish (DANBIO) biologics registers, we assembled 8703 (ARTIS=5448, DANBIO=3255) patients with SpA initiating a first TNFi 2001-2011. From the Swedish National Patient and Population Registers we assembled a TNFi-na?ve SpA cohort (n=28,164) and a Swedish age-matched and sex-matched general population comparator cohort (n=131?687). We identified incident cancers by linkage with the nationwide Swedish and Danish Cancer Registers 2001-2011, and calculated age-standardised and sex-standardised incidence ratios as measures of relative risk (RR).RESULTS: Based on 1188 cancers among the TNFi-na?ve patients with SpA, RR of cancer overall was 1.1 (95% CI 1.0 to 1.2). Based on 147 cancers among TNFi initiators with SpA, RR versus TNFi-na?ve was 0.8 (95% CI 0.7 to 1.0) and results were similar for AS and PsA when analysed separately. Site-specific cancer RRs: prostate 0.5 (95% CI 0.3 to 0.8), lung 0.6 (95% CI 0.3 to 1.3), colorectal 1.0 (95% CI 0.5 to 2.0), breast 1.3 (95% CI 0.9 to 2.0), lymphoma 0.8 (95% CI 0.4 to 1.8) and melanoma 1.4 (95% CI 0.7 to 2.6).CONCLUSIONS: In patients with SpA, treatment with TNFi was not associated with increased risks of cancer, neither overall nor for the six most common cancer types.

引自：Hellgren K, Dreyer L, Arkema EV, et al. Cancer risk in patients with spondyloarthritis treated with TNF inhibitors: a collaborative study from the ARTIS and DANBIO registers. Ann Rheum Dis. 2016, May 4. pii: annrheumdis-2016-209270. doi: 10.1136/annrheumdis-2016-209270. [Epub ahead of print]