Background: TNF inhibitors (TNFi) effectively treat rheumatoid arthritis but may increase patient risk of some malignancies, particularly lymphomas or skin cancers. Methods: We used Surveillance, Epidemiology, and End Results (SEER)–Medicare data to conduct a case–control study in patients with rheumatoid arthritis (2007–2015). Cases were individuals with a first cancer diagnosed in SEER registries (ages 66–99, 22 cancer sites, N = 10,263). Skin cancer cases [nonmelanoma skin cancer (NMSC, N = 501), basal cell carcinoma (BCC, N = 161), squamous cell carcinoma (SCC, N = 150)] and cancer-free controls ( N = 30,475) were selected from Medicare beneficiaries residing in SEER areas. Cases and controls had prior Medicare claims-based evidence for rheumatoid arthritis, and TNFi exposure was ascertained from part B and part D claims. Logistic regression was used to estimate adjusted odds ratios (aOR). Results: TNFi exposure was present in 16.2% of controls and 12.8% to 33.7% of cancer cases, varying by site. TNFi use was associated with increased risk of NMSC overall (aOR 1.32, 95% confidence interval 1.06–1.63), non-Hodgkin lymphoma (NHL) overall (1.28, 1.06–1.56) and, specifically, follicular lymphoma (2.63, 1.63–4.24). TNFi exposure was not associated with other SEER cancer sites, BCC or SCC specifically, or other common NHL subtypes. Conclusions: Among older adults with rheumatoid arthritis, TNFi exposure was associated with elevated risk of NMSC and NHL, driven specifically by follicular lymphoma. Exposure was not associated with increased risk for other cancer sites. Impact: Our results support a role for TNF in lymphomagenesis. Given the association with NMSC, patients initiating TNFi therapy may benefit from skin cancer screening and sun protection measures. This article is featured in Highlights of This Issue, [p. 1979][1] [1]: /lookup/volpage/30/1979?iss=11

中文翻译：

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肿瘤坏死因子抑制剂和美国类风湿关节炎老年人患癌症的风险

背景：TNF 抑制剂 (TNFi) 可有效治疗类风湿性关节炎，但可能会增加患者患某些恶性肿瘤的风险，尤其是淋巴瘤或皮肤癌。方法：我们使用监测、流行病学和最终结果 (SEER)-Medicare 数据对类风湿性关节炎患者（2007-2015 年）进行病例对照研究。病例是在 SEER 登记处诊断出首例癌症的个体（年龄 66-99 岁，22 个癌症部位，N = 10,263）。皮肤癌病例 [非黑色素瘤皮肤癌 (NMSC, N = 501)、基底细胞癌 (BCC, N = 161)、鳞状细胞癌 (SCC, N = 150)] 和无癌对照 (N = 30,475) 选自居住在 SEER 地区的医疗保险受益人。病例和对照之前有基于医疗保险索赔的类风湿性关节炎证据，并且从 B 部分和 D 部分的索赔中确定了 TNFi 暴露。逻辑回归用于估计调整优势比 (aOR)。结果：16.2% 的对照组和 12.8% 至 33.7% 的癌症病例存在 TNFi 暴露，因部位而异。TNFi 的使用与 NMSC 总体风险增加相关（aOR 1.32，95% 置信区间 1.06-1.63），非霍奇金淋巴瘤（NHL）总体风险增加（1.28，1.06-1.56），特别是滤泡性淋巴瘤（2.63，1.63-4.24） ）。TNFi 暴露与其他 SEER 癌症部位、BCC 或 SCC 或其他常见 NHL 亚型无关。结论：在患有类风湿性关节炎的老年人中，TNFi 暴露与 NMSC 和 NHL 风险升高有关，特别是由滤泡性淋巴瘤驱动。暴露与其他癌症部位的风险增加无关。影响：我们的结果支持 TNF 在淋巴瘤发生中的作用。鉴于与 NMSC 的关联，开始 TNFi 治疗的患者可能会受益于皮肤癌筛查和防晒措施。这篇文章被收录在本期的亮点中，[p. 1979][1][1]：/lookup/volpage/30/1979?iss=11