Autoimmune Skin Diseases and Survival Outcomes After Antineoplastic Treatment in Patients With Cancer.

IF 11.5 1区 医学 Q1 DERMATOLOGY
Sheng-Yin To, Cho-Hao Lee, Yi-Hsien Chen, Li-Fan Hsu, I-Wen Chen, Hui-Wen Yang, Yuan-Liang Wen, Li-Ting Kao
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引用次数: 0

Abstract

Importance: Autoimmune skin diseases (ASDs) and cancer both involve immune system dysregulation, with ASDs characterized by heightened immune activity, and cancer associated with immune evasion; however, their impact on cancer prognosis remains unclear.

Objective: To investigate the association of ASDs with cancer prognosis and survival outcomes after antineoplastic treatment in patients with cancer.

Design, setting, and participants: This population-based cohort study used data from Taiwan's Nationwide Cancer Registry and National Health Insurance Database to evaluate survival outcomes in patients with cancer who received antineoplastic treatment (ie, chemotherapy, targeted therapy, or immunotherapy) between January 1, 2019, and June 30, 2021. Data were analyzed from July 2023 to April 2025.

Exposures: ASDs, including alopecia areata, Sjögren syndrome, vitiligo, cutaneous lupus erythematosus, psoriasis, lichen planus, autoimmune bullous diseases, systemic sclerosis, morphea, hidradenitis, and dermatomyositis.

Main outcome and measures: All-cause mortality and cancer-specific mortality were assessed during the follow-up period. To account for potential confounding, both inverse probability of treatment weighting (IPTW) and propensity score matching strategies were applied. Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) for all-cause mortality, while the Fine-Gray hazard model was used to estimate subdistribution HRs (SHRs) for cancer-specific mortality, with noncancer-related deaths considered as competing events.

Results: Of 197 895 patients included in the analysis, 26 008 were in the ASD group (mean [SD] age, 64.0 [13.3] years; 14 969 female [57.6%]) and 171 887 were in the non-ASD group (mean [SD] age, 62.8 [13.0] years; 80 525 female [46.9%]). Patients with ASDs had significantly better survival outcomes than those without ASDs, with an IPTW-adjusted HR of 0.94 (95% CI, 0.92-0.96) for all-cause mortality and an SHR of 0.94 (95% CI, 0.92-0.96) for cancer-specific mortality. These associations remained consistent in propensity score-matched analyses. Among ASD subtypes, alopecia areata and Sjögren syndrome were consistently associated with lower mortality risk.

Conclusions and relevance: This population-based cohort study found that patients with ASDs had significantly better cancer survival outcomes than those without ASDs. This finding suggests that there is a potential immunological association between ASDs and cancer prognoses, highlighting the need for further investigation into the underlying mechanisms and the implications for oncologic management.

自身免疫性皮肤病和癌症患者抗肿瘤治疗后的生存结果
重要性:自身免疫性皮肤病(ASDs)和癌症都涉及免疫系统失调,ASDs以免疫活性升高为特征,而癌症与免疫逃避相关;然而,它们对癌症预后的影响尚不清楚。目的:探讨asd与肿瘤预后及肿瘤患者抗肿瘤治疗后生存结局的关系。设计、环境和参与者:这项基于人群的队列研究使用了台湾全国癌症登记和国民健康保险数据库的数据,以评估2019年1月1日至2021年6月30日期间接受抗肿瘤治疗(即化疗、靶向治疗或免疫治疗)的癌症患者的生存结果。数据分析时间为2023年7月至2025年4月。暴露:asd,包括斑秃、Sjögren综合征、白癜风、皮肤红斑狼疮、牛皮癣、扁平苔藓、自身免疫性大疱性疾病、系统性硬化症、脑脊液、汗腺炎和皮肌炎。主要结局和措施:在随访期间评估全因死亡率和癌症特异性死亡率。为了解释潜在的混淆,应用了治疗加权逆概率(IPTW)和倾向评分匹配策略。Cox比例风险回归模型用于估计全因死亡率的风险比(hr),而Fine-Gray风险模型用于估计癌症特异性死亡率的亚分布hr (SHRs),非癌症相关死亡被视为竞争事件。结果:纳入分析的197895例患者中,26008例为ASD组(平均[SD]年龄64.0[13.3]岁;女性14 969例(57.6%),非asd组171 887例(平均[SD]年龄62.8[13.0]岁;女性80525人[46.9%])。asd患者的生存结果明显优于无asd患者,经iptwr校正的全因死亡率比为0.94 (95% CI, 0.92-0.96),癌症特异性死亡率比为0.94 (95% CI, 0.92-0.96)。这些关联在倾向评分匹配分析中保持一致。在ASD亚型中,斑秃和Sjögren综合征始终与较低的死亡风险相关。结论及相关性:这项基于人群的队列研究发现,asd患者的癌症生存结果明显优于无asd患者。这一发现表明自闭症谱系障碍与癌症预后之间存在潜在的免疫学关联,强调需要进一步研究其潜在机制及其对肿瘤治疗的影响。
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来源期刊
JAMA dermatology
JAMA dermatology DERMATOLOGY-
CiteScore
14.10
自引率
5.50%
发文量
300
期刊介绍: JAMA Dermatology is an international peer-reviewed journal that has been in continuous publication since 1882. It began publication by the American Medical Association in 1920 as Archives of Dermatology and Syphilology. The journal publishes material that helps in the development and testing of the effectiveness of diagnosis and treatment in medical and surgical dermatology, pediatric and geriatric dermatology, and oncologic and aesthetic dermatologic surgery. JAMA Dermatology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications. It is published online weekly, every Wednesday, and in 12 print/online issues a year. The mission of the journal is to elevate the art and science of health and diseases of skin, hair, nails, and mucous membranes, and their treatment, with the aim of enabling dermatologists to deliver evidence-based, high-value medical and surgical dermatologic care. The journal publishes a broad range of innovative studies and trials that shift research and clinical practice paradigms, expand the understanding of the burden of dermatologic diseases and key outcomes, improve the practice of dermatology, and ensure equitable care to all patients. It also features research and opinion examining ethical, moral, socioeconomic, educational, and political issues relevant to dermatologists, aiming to enable ongoing improvement to the workforce, scope of practice, and the training of future dermatologists. JAMA Dermatology aims to be a leader in developing initiatives to improve diversity, equity, and inclusion within the specialty and within dermatology medical publishing.
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