Markedly reduced risk of internal malignancies in patients with vitiligo: A nationwide population-based cohort study

Jung Min Bae, Kee Yang Chung, Sook Jung Yun, Heesu Kim, Byung Cheol Park, Joung Soo Kim, Soo-Hong Seo, Hyo Hyun Ahn, Dong Youn Lee, You Chan Kim, Hyang Joon Park, Miri Kim

Research output: Contribution to journalArticle

Abstract

PURPOSE Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated. PATIENTS AND METHODS We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained fromJanuary 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group). RESULTS A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95% CI, 0.82 to 0.89; P,.001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95% CI, 0.55 to 0.69; P , .001), ovary (HR, 0.62; 95% CI, 0.46 to 0.83; P <001), and lung (HR, 0.75; 95% CI, 0.65 to 0.86; P <001). CONCLUSION Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ.

Original languageEnglish
Pages (from-to)903-911
Number of pages9
JournalJournal of Clinical Oncology
Volume37
Issue number11
DOIs
Publication statusPublished - 2019 Jan 1

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Vitiligo
Cohort Studies
Population
Neoplasms
Control Groups
Melanocytes
National Health Programs
Skin Neoplasms
Rectal Neoplasms
Autoimmunity
Colonic Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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Markedly reduced risk of internal malignancies in patients with vitiligo : A nationwide population-based cohort study. / Bae, Jung Min; Chung, Kee Yang; Yun, Sook Jung; Kim, Heesu; Park, Byung Cheol; Kim, Joung Soo; Seo, Soo-Hong; Ahn, Hyo Hyun; Lee, Dong Youn; Kim, You Chan; Park, Hyang Joon; Kim, Miri.

In: Journal of Clinical Oncology, Vol. 37, No. 11, 01.01.2019, p. 903-911.

Research output: Contribution to journalArticle

Bae, JM, Chung, KY, Yun, SJ, Kim, H, Park, BC, Kim, JS, Seo, S-H, Ahn, HH, Lee, DY, Kim, YC, Park, HJ & Kim, M 2019, 'Markedly reduced risk of internal malignancies in patients with vitiligo: A nationwide population-based cohort study', Journal of Clinical Oncology, vol. 37, no. 11, pp. 903-911. https://doi.org/10.1200/JCO.18.01223
Bae, Jung Min ; Chung, Kee Yang ; Yun, Sook Jung ; Kim, Heesu ; Park, Byung Cheol ; Kim, Joung Soo ; Seo, Soo-Hong ; Ahn, Hyo Hyun ; Lee, Dong Youn ; Kim, You Chan ; Park, Hyang Joon ; Kim, Miri. / Markedly reduced risk of internal malignancies in patients with vitiligo : A nationwide population-based cohort study. In: Journal of Clinical Oncology. 2019 ; Vol. 37, No. 11. pp. 903-911.
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abstract = "PURPOSE Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated. PATIENTS AND METHODS We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained fromJanuary 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group). RESULTS A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95{\%} CI, 0.82 to 0.89; P,.001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95{\%} CI, 0.55 to 0.69; P , .001), ovary (HR, 0.62; 95{\%} CI, 0.46 to 0.83; P <001), and lung (HR, 0.75; 95{\%} CI, 0.65 to 0.86; P <001). CONCLUSION Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ.",
author = "Bae, {Jung Min} and Chung, {Kee Yang} and Yun, {Sook Jung} and Heesu Kim and Park, {Byung Cheol} and Kim, {Joung Soo} and Soo-Hong Seo and Ahn, {Hyo Hyun} and Lee, {Dong Youn} and Kim, {You Chan} and Park, {Hyang Joon} and Miri Kim",
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T1 - Markedly reduced risk of internal malignancies in patients with vitiligo

T2 - A nationwide population-based cohort study

AU - Bae, Jung Min

AU - Chung, Kee Yang

AU - Yun, Sook Jung

AU - Kim, Heesu

AU - Park, Byung Cheol

AU - Kim, Joung Soo

AU - Seo, Soo-Hong

AU - Ahn, Hyo Hyun

AU - Lee, Dong Youn

AU - Kim, You Chan

AU - Park, Hyang Joon

AU - Kim, Miri

PY - 2019/1/1

Y1 - 2019/1/1

N2 - PURPOSE Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated. PATIENTS AND METHODS We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained fromJanuary 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group). RESULTS A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95% CI, 0.82 to 0.89; P,.001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95% CI, 0.55 to 0.69; P , .001), ovary (HR, 0.62; 95% CI, 0.46 to 0.83; P <001), and lung (HR, 0.75; 95% CI, 0.65 to 0.86; P <001). CONCLUSION Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ.

AB - PURPOSE Recent studies indicated that the autoimmunity of vitiligo exerts effects on cells other than melanocytes, which confer reduced risks of both melanoma and nonmelanoma skin cancers in patients with vitiligo. However, the risk of internal malignancy in patients with vitiligo has not been elucidated. PATIENTS AND METHODS We conducted a population-based retrospective cohort study using data from the Korean National Health Insurance claims database obtained fromJanuary 2007 to December 2016. All patients age 20 years or older with vitiligo who had at least two contacts with a physician from 2009 to 2016, during which a principal diagnosis was made, were identified (vitiligo group). Controls were randomly selected (two per patient with vitiligo) after frequency matching with the vitiligo group for age and sex during the same period (control group). RESULTS A total of 101,078 patients with vitiligo and 202,156 controls without vitiligo were included. The incidence rates of internal malignancies were 612.9 and 708.9 per 100,000 person-years in the vitiligo and control groups, respectively. Patients with vitiligo showed a significantly reduced risk of overall internal malignancies (hazard ratio [HR], 0.86; 95% CI, 0.82 to 0.89; P,.001) compared with controls without vitiligo after adjustments for age, sex, and comorbidities. With regard to organ-specific malignancies, patients with vitiligo showed a remarkably decreased risk of cancer in the colon and rectum (HR, 0.62; 95% CI, 0.55 to 0.69; P , .001), ovary (HR, 0.62; 95% CI, 0.46 to 0.83; P <001), and lung (HR, 0.75; 95% CI, 0.65 to 0.86; P <001). CONCLUSION Vitiligo was associated with a reduced risk of overall internal malignancies. These findings suggest that autoimmune diseases, including vitiligo, may provide immune surveillance for the development of cancer beyond the targeted organ.

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