Öz
Amaç
Malignite romatizmal hastalıklarda önemli bir komorbiditedir. Bu çalışmada bir romatoloji kliniğinde takip edilen romatizmal ve non-enflamatuvar hastalıkları olan bireylerde malignitelerin insidansı, prevalansı ve risk faktörleri araştırılmaktadır.
Yöntem
Ocak 2021 ile Ocak 2024 arasında takip edilen 2.600 hasta üzerinde retrospektif bir analiz yapıldı. Toplanan veriler arasında hastaların demografik özellikleri, romatizmal hastalık türleri, enflamatuvar olmayan durumlar, tedaviler ve kanser geçmişine yer verildi. İstatistiksel analizlerden ki-kare, Fisher kesin olasılık ve Mann-Whitney U testleri, lojistik regresyon analizi ve standart insidans oranı (SIR) hesaplamaları kullanıldı.
Bulgular
2.600 hastanın 100’ünde kanser öyküsü saptandı. Ortalama yaş 66 olup malignite öyküsü olanlarda olmayanlara göre daha yüksekti (p<0,001). Meme kanseri en sık görülen malignite (%29) olup, bunu jinekolojik ve solunum sistemi kanserleri takip etmekteydi. Kanser prevalansı romatoid artrit (RA) ve osteoartrit hastalarında daha yüksek, ankilozan spondilit ve fibromiyalji hastalarında ise daha düşüktü. Yirmi altı hastaya romatizmal veya enflamatuvar olmayan bir durumun başlangıcından sonra kanser tanısı konuldu. Kadın hastalarda jinekolojik kanserler [SIR=3,76, %95 güven aralığı (GA)=1,2-8,7, p=0,005] ve lenfoma (SIR=8,14, GA=1,6-23,7, p=0,001) daha sık görüldü. Erkek hastalarda toplam kanser sayısı anlamlı derecede yüksekti (SIR=381, GA=182,7-700,8, p<0,001). Ayrıca, nivolumab ile tedavi edilen iki hastada yeni başlayan RA ve psoriatik artrit gelişirken, ribosiklib ile tedavi edilen bir hastada sistemik skleroz gelişti. Lojistik regresyonda yaş [odds oranı (OR)=1,06], erkek cinsiyet (OR=2,16), enflamatuvar hastalık öyküsü (OR=4,52) ve Charlson komorbidite indeks skorunun (OR=5,65) kanser gelişiminde önemli belirleyiciler olduğunu saptandı.
Sonuç
Bu çalışma romatizmal hastalığı olan özellikle yaşlı bireylerde kanser taramasının gerekliliğini vurgulamaktadır. Bu hastalar için hedefe yönelik kanser önleme ve yönetim stratejileri geliştirme odaklı prospektif çalışmalara ihtiyaç vardır.
Anahtar Kelimeler: Neoplazmalar, lenfoma, romatoid artrit, otoimmün hastalıklar
Kaynakça
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