肉芽肿性多血管炎与头颈癌关联分析

Analysis of the correlation between granulomatosis with polyangiitis and head and neck cancer

目的评估新诊断或既往诊断为肉芽肿性多血管炎(GPA)患者罹患头颈癌的风险。方法全部数据来源于TriNetX Analytics Network联合研究平台,共计纳入临床随访信息完整的研究对象13094188例,分为实验组(GPA患者20663例)及对照组(非GPA患者13073525例)。记录2组患者在最初诊断为GPA的同时或之后罹患鼻腔/鼻咽、口腔、口咽和喉/下咽恶性肿瘤的患者,参与者的特征按各协变量[年龄、性别、种族、头颈部癌症(HNC)危险因素]进行分层,并使用单向方差分析和卡方检验进行比较。相关的混杂变量,包括人乳头瘤病毒、烟草和酒精暴露,在分层队列之间进行了匹配。通过COX比例风险回归模型计算2组患者患HNC的危险比(HR)和相应95%可信区间(CI),以评估GPA对HNC发生的影响。结果在GPA患者中,分别有22例(0.11%)、59例(0.29%)、15例(0.08%)和18例(0.09%)同时被诊断为鼻腔/鼻咽、口腔、口咽和喉部的恶性肿瘤。将GPA患者与标准化对照人群进行比较时,GPA患者发生鼻腔/鼻咽恶性肿瘤的风险至少高出2倍[HR值(95%CI)=2.20(1.04,4.65),P<0.001]。结论本研究发现,GPA患者罹患鼻腔/鼻咽癌的风险在统计学上显著增加。但仍需要更多的大型人口数据调查来证实这些相关发现。

Objective To assess the risk of head and neck cancer in patients with newly or previously diagnosed granulomatosis with polyangiitis(GPA).Methods All data were extracted from the TriNetX Analytics Network joint research platform.A total of 13094188 subjects with complete clinical follow-up information were included in the study.Patients were divided into the experimental group(GPA patients,n=20663)and the control group(non-GPA patients,n=13073525).Patients with the diagnosis of malignant tumors occurred in sinonasal/nasopharynx,oral cavity,oropharynx,and larynx/hypopharynx concurrently or after the initial encounter diagnosis of GPA were recorded.The characteristics of participants were stratified according to covariate(age,gender,race,HNC risk factor)and compared using one-way analysis of variance and chi-square test.Relevant confounding variables,including human papillomavirus,smoking,and alcohol exposure,were matched among stratified cohorts.COX proportional hazards model was used to calculate the hazard ratios(HR)and corresponding 95%confidence interval(CI)of HNC in two groups to evaluate the impact of GPA on the occurrence of HNC.Results Of the patients within the GPA group,22(0.11%),59(0.29%),15(0.08%),and 18(0.09%)had an encounter diagnosis of malignancy of the sinonasal/nasopharynx,oral cavity,oropharynx,and larynx,respectively.When comparing the patients of the experimental group with the standardized control population,the risk of developing nasal/nasopharyngeal malignancies in GPA patients was at least twice higher[HR(95%CI)=2.20(1.04,4.65),P<0.001].Conclusion This study identified a statistically significant increase in the risk of sinonasal/nasopharyngeal cancer in patients with GPA.However,additional large-scale population investigations are still needed to confirm these correlation.