Background Cancer can cause mortality in systemic sclerosis (SSc). We investigated the association between cancer and SSc using the Clinical Practice Research Datalink (CPRD). Methods A validated case-ascertainment strategy identified SSc patients in the CPRD. A cohort study design examined cancer occurrence following SSc, with SSc patients matched to six non-SSc comparators by age, sex and GP-practice. Prevalent and incident cases of SSc were analysed separately. Descriptive statistics and Cox analyses determined hazard ratios for cancer occurrence. A case-control study (matched 1:6) examined cancer occurrence prior to SSc. Results From 10.1 million individuals in CPRD, 1,588 of cases of SSc were identified. Two hundred and six cancers followed SSc diagnosis (116 in prevalent and 90 in incident cohort). Commonest cancers were mucocutaneous (4.5%), lung (2.1%) and breast (1.9%). The proportion of SSc patients developing cancer was significantly higher than non-SSc in both incident (11.2% vs 9.7%, p= 0.02) and prevalent cohorts (14.8% vs 12.1%, p= 0.03); particularly for lung cancer (2.6% vs 0.9% in prevalent cohort, p< 0.001). Overall incidence of cancer in the SSc groups was 17.6/1000 person years, compared with 13.9/1000 person years in non-SSc group. The adjusted hazard ratios for cancer was 1.41 (95% CI 1.14–1.75) and 1.32 (95% CI 1.04–1.67) for prevalent and incident SSc respectively. No increased risk of cancer prior to SSc diagnosis was identified in case-control study. Conclusion We have identified an increased risk of cancer diagnosis following, but not before, SSc diagnosis. Our findings could support screening recommendations for cancer in SSc.

中文翻译：

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英国的系统性硬化症和癌症：使用临床实践研究数据链进行流行病学分析


背景 癌症可导致系统性硬化症 (SSc) 患者死亡。我们使用临床实践研究数据链 (CPRD) 研究了癌症与 SSc 之间的关联。方法 经验证的病例确定策略确定了 CPRD 中的 SSc 患者。一项队列研究设计检查了 SSc 后癌症的发生情况，其中 SSc 患者与六名非 SSc 比较者按年龄、性别和全科医生执业情况进行匹配。分别分析了 SSc 的流行病例和偶发病例。描述性统计和 Cox 分析确定了癌症发生的风险比。一项病例对照研究（1:6 匹配）检查了 SSc 之前的癌症发生情况。结果 在 CPRD 的 1,010 万人中，发现了 1,588 例 SSc 病例。 SSc 诊断后有 206 种癌症（116 种为流行癌症，90 种为事件队列）。最常见的癌症是皮肤粘膜癌（4.5%）、肺癌（2.1%）和乳腺癌（1.9%）。在事件组（11.2% vs 9.7%，p=0.02）和流行组（14.8% vs 12.1%，p=0.03）中，SSc 患者发展为癌症的比例均显着高于非 SSc 患者；特别是对于肺癌（流行队列中为 2.6% vs 0.9%，p< 0.001）。 SSc 组的癌症总体发病率为 17.6/1000 人年，而非 SSc 组的癌症总发病率为 13.9/1000 人年。对于流行性 SSc 和偶发性 SSc，调整后的癌症风险比分别为 1.41 (95% CI 1.14–1.75) 和 1.32 (95% CI 1.04–1.67)。病例对照研究中未发现 SSc 诊断前患癌症的风险增加。结论 我们发现，在 SSc 诊断之后而非之前，癌症诊断的风险会增加。我们的研究结果可以支持 SSc 癌症筛查建议。