较早的研究发现，与普通人群相比，类风湿性关节炎患者患癌症的风险增加了 10% 至 30%，但缺乏有关罕见癌症的数据。近年来，重大治疗突破可能通过减轻疾病活动或相反通过削弱抗肿瘤免疫反应来影响这种癌症风险。本研究的目的是根据治疗暴露情况，比较接受治疗的类风湿性关节炎患者与普通人群的癌症风险。这是法国国家索赔数据库“Système National des Données”中的一项全国性基于人群的研究de Santé”（SNDS）于2010年1月1日至2020年12月31日期间，以法国人口为参考（通过使用法国基于人群的癌症登记网络 [FRANCIM]）。在研究期间，257,074 名接受治疗的类风湿性关节炎患者总共贡献了 2,098,238 人年的主要分析数据。类风湿性关节炎患者的所有癌症风险增加，SIR（标准化发病率）为 1.20（95% CI [1.17-1.23]）。这种风险尤其增加，尤其是肺（SIR 1.41，95% CI [1.36-1.46]）、膀胱（SIR 2.38 95% CI [2.25-2.51]）、子宫颈（SIR 1.80，95% CI [1.62-2.01]）、前列腺（SIR 1.08，95% CI [1.04，1.13]）癌症、黑色素瘤（SIR 1.37，95% CI [1.29-1.46]）、弥漫性大 B 细胞淋巴瘤（SIR 1.79，95% CI [1.63-1.96]）、多发性骨髓瘤（SIR 1.42，95% CI [1.27-1.60]）和霍奇金淋巴瘤（SIR 2.73，95% CI [2.31-3.23]）。某些癌症的发病率低于一般人群，例如胰腺癌（SIR 0.90，95% CI） [0.83-0.97]）以及乳腺癌和子宫内膜癌（分别为 SIR 0.91, 95% CI [0.88-0.94] 和 SIR 0.77, 95% CI [0.71-0.84]）。虽然我们观察到适度但显着的相对增加随着时间的推移，类风湿性关节炎患者的所有癌症风险呈下降趋势，非霍奇金淋巴瘤的风险呈下降趋势。接受利妥昔单抗治疗的患者是癌症风险最高的患者。与一般人群相比，接受治疗的类风湿性关节炎患者患癌症的风险最高。患者患全癌症和某些特定部位癌症的风险更大，但乳腺癌、胰腺癌和子宫内膜癌除外，这些癌症的发病率低于一般人群。这项工作得到了 InCA（国家抗癌研究所）和AP-HP（巴黎公共医院援助）。© 2023 作者。由爱思唯尔有限公司出版

Older studies uncovered an increased risk of cancer in patients with rheumatoid arthritis between 10% and 30% compared to the general population, with a lack of data concerning infrequent cancers. In recent year, major therapeutic breakthroughs might have affected this risk of cancer by mitigating disease activity or on the contrary by impairing antitumoral immune response. The objectives of this study are to compare cancer risk in patients with treated rheumatoid arthritis to the general population, in all treated patients and according to treatment exposure.This is a nationwide population-based study within the French national claims database "Système National des Données de Santé" (SNDS) between January 1st 2010 and December 31st 2020, to estimate the age and sex-standardized incidence ratios of cancer (all sites and site specific) of treated rheumatoid arthritis patients, with the French population as reference (by use of the French Network of Population-Based Cancer Registries [FRANCIM]).During the study period, 257,074 treated patients with rheumatoid arthritis contributed to a total of 2,098,238 person-years for the main analysis. The all-cancer risk was increased in rheumatoid arthritis patients, with a SIR (Standardized Incidence Ratio) of 1.20 (95% CI [1.17-1.23]). This risk was increased particularly for lung (SIR 1.41, 95% CI [1.36-1.46], bladder (SIR 2.38 95% CI [2.25-2.51]), cervix (SIR 1.80, 95% CI [1.62-2.01]), prostate (SIR 1.08, 95% CI [1.04, 1.13]) cancers, melanoma (SIR 1.37, 95% CI [1.29-1.46]), diffuse large B cell lymphoma (SIR 1.79, 95% CI [1.63-1.96], multiple myeloma (SIR 1.42, 95% CI [1.27-1.60]) and Hodgkin's lymphoma (SIR 2.73, 95% CI [2.31-3.23]). Some cancers were less frequent than in the general population such as pancreatic (SIR 0.90, 95% CI [0.83-0.97]) as well as breast and endometrial cancers (SIR 0.91, 95% CI [0.88-0.94] and SIR 0.77, 95% CI [0.71-0.84] respectively). Although we observed a modest but significant relative increase of all-cancer risk over-time in rheumatoid arthritis patients, there was a trend towards a decrease in risk of non-Hodgkin's lymphoma. Patients treated with rituximab were the patients displaying the highest risk of cancer.Compared to the general population, treated rheumatoid arthritis patients were at greater risk of all-cancer and some site specific cancers, except for breast, pancreatic and endometrial cancers which were less frequent than in the general population.This work was supported by unrestricted grants from the InCA (national institute against cancer) and AP-HP (Assistance Publique des Hôpitaux de Paris).© 2023 The Authors. Published by Elsevier Ltd.