来自t rkiye关于多发性硬化症癌症风险和治疗暴露的真实证据：一项组织病理学验证的、基于登记的研究

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2025-05-24 DOI:10.1016/j.msard.2025.106547

Bilgin Öztürk , Esra Taşkıran , Serkan Demir , Mustafa Murat Arat , Aksel Siva , Naim Ata , Şuayip Birinci , Murat Kürtüncü

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引用次数: 0

摘要

多发性硬化症（MS）是一种慢性、免疫介导的神经系统疾病，与疾病修饰疗法（dmt）或免疫抑制剂有关，具有潜在的恶性肿瘤风险。本研究旨在评估美国多发性硬化症患者恶性肿瘤的流行病学，并研究DMT/免疫抑制剂暴露对癌症风险的影响。方法本研究使用土耳其卫生部的电子数据库，通过ICD-10代码识别82025例MS患者。纳入要求≥3次MS诊断或1次MS诊断并至少有1种MS特异性DMT或可用于MS治疗的免疫抑制剂处方（干扰素、醋酸格拉替默、芬戈莫德、那他单抗、奥克雷单抗、阿仑单抗、富马酸二甲酯、特立氟米特、硫唑嘌呤、环磷酰胺、甲氨蝶呤、米托蒽醌、霉酚酸和利妥昔单抗）。在病理报告中使用ICD-O编码，根据组织病理学确认对恶性肿瘤进行分类。根据土耳其卫生部数据库的报告，按性别分析多发性硬化症患者的癌症系统分布，并与普通人群中年龄调整后的癌症发病率进行比较。我们还比较了接受特定治疗的患者与未接受该药物治疗的患者的癌症发病率。结果82025例MS患者中，女性占68.3%，男性占31.7%，平均诊断年龄34.8±13.0岁。其中1212人患上癌症，其中女性占73.5%。乳腺癌在女性中最常见（29.2%），而男性主要发生呼吸系统、胃肠道和泌尿系统的癌症。MS患者皮肤、女性生殖器、乳腺、甲状腺和总体癌症的年龄调整发病率与一般人群相似。值得注意的是，硫唑嘌呤的使用与更高的癌症风险相关（OR: 1.24, 95% CI: 1.01-1.51, p = 0.032），而克拉德里滨、富马酸二甲酯和b细胞疗法的癌症发病率较低。结论：本研究表明，与一般人群相比，多发性硬化症似乎不会增加患癌症的风险，除了硫唑嘌呤外，没有一种多发性硬化症治疗与患癌症的风险增加有关。

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Real-world evidence from Türkiye on cancer risk and treatment exposure in multiple sclerosis: A histopathology-verified, registry-based study

Background

Multiple sclerosis (MS) is a chronic, immune-mediated neurological disease with potential malignancy risks linked to disease-modifying therapies (DMTs) or immunosuppressants. This study aims to evaluate the epidemiology of malignancies in MS patients across T..rkiye and examine the impact of DMT/Immunosuppressant exposure on cancer risk.

Methods

The study used the Turkish Ministry of Health's electronic database to identify 82,025 MS patients through ICD-10 codes. Inclusion required ≥3 MS diagnoses or one MS diagnosis with at least one MS-specific DMT or immunosuppressants prescription which can be used for MS treatments (interferons, glatiramer acetate, fingolimod, natalizumab, ocrelizumab, alemtuzumab, dimethyl fumarate, teriflunomide, azathioprine, cyclophosphamide, methotrexate, mitoxantrone, mycophenolic acid, and rituximab). Malignancies were classified based on histopathological confirmation, using ICD-O codes in pathology reports. Systemic distributions of cancers in MS patients were analyzed by sex and compared with age-adjusted cancer incidence rates from the general population, as reported in the Turkish Ministry of Health database. We also compared cancer rates in patients exposed to a specific treatment with those observed in patients not exposed to that drug.

Results

Of the 82,025 patients with MS, 68.3 % were females and 31.7 % males, with an average diagnosis age of 34.8 ± 13.0 years. Among them, 1212 developed cancers, with females accounting for 73.5 % of the cases. Breast cancer was most common in females (29.2 %), while males primarily developed cancers of the respiratory, gastrointestinal, and urinary systems. The age-adjusted incidence rates of skin, female genital, breast, thyroid, and overall cancers in MS patients were similar to those reported in the general population. Notably, azathioprine use was linked to a significantly higher cancer risk (OR: 1.24, 95 % CI: 1.01–1.51, p = 0.032), whereas treatments like cladribine, dimethyl fumarate, and B-cell therapies showed a lower cancer incidence.

Conclusions

This study demonstrated that Multiple sclerosis does not appear to increase the risk of cancer compared to the general population and none of the MS treatments, except for azathioprine, were associated with an increased risk of cancer.

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.