强直性脊柱炎合并恶性肿瘤31例

Clinical analysis of 31 ankylosing spondylitis patients with malignancies

目的：分析强直性脊柱炎患者合并恶性肿瘤的临床特点。方法：选择北京大学第一医院2006年1月至2014年7月明确诊断为强直性脊柱炎合并恶性肿瘤的31例住院患者,与同时期住院的强直性脊柱炎未合并肿瘤患者的临床特点进行比较。并对其一般情况、强直性脊柱炎的临床与影像学表现、肿瘤的特征、预后等进行回顾性分析。结果：31例患者包括男性27例（87%）,女性4例（13%）,确诊强直性脊柱炎的平均年龄为（43±17）岁（16~76岁）;首次确诊肿瘤的平均年龄为（60±12）岁（31~87岁）,其中27例患者的肿瘤发生在强直性脊柱炎确诊之后。31例患者确诊强直性脊柱炎时均存在典型的影像学表现,大部分未接受针对强直性脊柱炎的规范化治疗。合并的恶性肿瘤者包括膀胱癌7例,血液系统肿瘤6例,肺癌5例,肾癌5例,前列腺癌、肾盂癌、乳腺癌、胃癌、直肠癌、神经内分泌瘤各2例,结肠癌和食管癌各1例。结论：强直性脊柱炎存在合并恶性肿瘤的风险,以膀胱癌最多见,其次是血液系统肿瘤,临床上需要关注。

Objective： To investigate the clinical features of patients with ankylosing spondylitis（ AS）and malignancies. Methods： In the study,31 AS patients with malignancies in Peking University First Hospital from January 2006 to July 2014 were enrolled,and their clinical features were compared with AS patients without malignancies at the same time in the hospital. Then their general characteristics,clinical and imaging findings of AS,characteristics of malignancies and prognosis were retrospectively analyzed.Results： The 31 cases of AS with malignacies accounted for 11. 8% of all AS patients admitted to the hospital in the same period. They comprised of 27 males（ 87%） and 4 females（ 13%）. Their mean ages at diagnosis of AS were 43 ± 17 years（ range： 16-76 years）,and their mean ages at diagnosis of malignancy were 60 ± 12 years（ range： 31-87 years） respectively. Malignancy was diagnosed after the establishment of AS in 27 of our patients. Furthermore,imaging changes typical of AS were found in all the 31 patients at the diagnosis of AS,but the majority of them had never received any proper treatment for AS.The malignancies of 31 AS patients included bladder cancer（ 7 cases）,hematological malignancy（ 6 cases）,lung cancer（ 5 cases）,renal cancer（ 5 cases）,prostate cancer（ 2 cases）,carcinoma of renal pelvis（ 2 cases）,breast cancer（ 2 cases）,gastric carcinoma（ 2 cases）,rectal cancer（ 2 cases）,neuroendocrine carcinoma（ 2 cases）,colon carcinoma（ 1 case）,and esophagus cancer（ 1 case）. Conclusion： There is risk of malignancy in AS. Malignancy is not rare in patients with AS. Bladder cancer is the most common one followed by hematological malignancy. In consequence,close attention should be paied to the conditon of AS with malignancy in clinical practice.