系统性硬化症与恶性肿瘤发生的Meta分析

A Meta Analysis of Malignancies and Systemic Sclerosis

[目的]探讨恶性肿瘤在系统性硬化症（SSc）中的发病风险和特征,为采取早期干预措施提供依据。[方法]检索Pub Med、Embas、Web of Science和中国期刊全文数据库,收集2017年5月之前国内外公开发表的相关文献。应用Stata11.0软件进行统计分析,合并不同条件下恶性肿瘤的标化发病比（SIR）及其95%可信区间（CI）,对于异质性较大的恶性肿瘤合并结果,通过Meta回归检验异质性来源。[结果]共纳入12篇研究,累积研究对象18927人。经Meta分析,恶性肿瘤的SIR为1.47（95%CI：1.28~1.68）,其中肺癌、非霍奇金淋巴瘤和血液系统肿瘤的SIR分别为3.16（95%CI：2.21~4.52）、2.60（95%CI：1.63~4.16）和2.57（95%CI：1.80~3.69）。男性SSc患者发生恶性肿瘤的总风险、肺癌、非霍奇金淋巴瘤以及血液系统恶性肿瘤的风险均高于女性患者。Meta回归结果显示患者的平均年龄（β=0.043,P=0.052）与研究的平均随访时间（β=-0.062,P=0.088）是恶性肿瘤可能异质性的因素,而患者平均年龄（β=0.138,P=0.045）是肺癌的可能异质性的因素。[结论]与普通人群相比,SSc患者中恶性肿瘤的发生率有所增加,尤其是肺癌、非霍奇金淋巴瘤和血液系统肿瘤的发病风险明显增加,因此在SSc患者的随访过程中需警惕恶性肿瘤的发生。

[Purpose] To analyze the risk and characteristics of malignancies among patients with systemic sclerosis（SSc）. [Methods] Studies on malignancy among SSc patients published before May 2017 were searched from databases Pub Med,Embas,Web of Science and China National Knowledge Internet. The report of standardized incidence rate of malignancies（SIR,95%CI） under different conditions was combined with software Stata11.0. [Results] Twelve studies with 18927 SSc patients were included in the Meta-analysis. The overall SIR of malignancy among SSc patients was 1.47（95%CI：1.28~1.68）. The combined SIR for lung cancer,non-Hodgkin＇s lymphoma and hematopoietic malignancies were 3.16（95%CI：2.21~4.52）, 2.60（95%CI：1.63~4.16） and 2.57（95%CI：1.80~3.69）,respectively. Compared to females the risk in males for developing malignancies in general,lung cancer,non-Hodgkin＇s lymphoma and hematopoietic malignancies was higher.Meta regression revealed that the mean age of patients（β=0.043,P=0.052） as well as mean follow-up period（β=-0.062,P=0.088） were heterogeneous factors for malignancy while mean age（β=0.138,P=0.045） was heterogeneous factor for lung cancer. [Conclusion] Compared with the general population,the incidence of malignancies in patients with SSc is slightly increased,while the risk of lung cancer,non-Hodgkin＇s lymphoma and hematopoietic cancers are significantly increased. Therefore,the development of malignancies should be cautioned during the follow up of patients with SSc.