先前的文献对于多发性硬化症 (PwMS) 患者的癌症风险存在分歧。因此，本研究比较了 PwMS 和来自法国普通人群的匹配样本的癌症风险。这项为期 10 年的全国回顾性匹配队列研究（2012-2021）使用了法国国家行政医疗保健数据库的数据（99% 的覆盖率）法国人口）来确定首次癌症发生的时间。 PwMS 是根据其长期疾病 (LTD) 状态、住院情况和多发性硬化症 (MS) 特定药物报销来确定的。对照组人群在年龄、性别、居住地、保险计划和队列入组日期方面按 4:1 匹配。如果参与者在入选前 3 年内没有癌症病史，则被纳入。通过LTD状态、住院治疗、化疗、放疗或前列腺癌特异性药物报销来识别癌症患者。从 Fine 和 Gray 模型中获得了首次发生癌症的总体风险比和癌症部位特异性风险比 (HR)，并报告了年龄和性别分层估计值。比较各组之间通过 3 个国家计划（乳腺癌、结直肠癌和宫颈癌）参与癌症筛查的情况。在 140,649 名 PwMS 中，癌症发病率为每 100,000 人年 (PYs) 799 例（n = 8,368），每 100,000 人年 (PYs) 736 例（n = 8,368）。 = 31,796）在 562,596 名匹配对照者中（70.8% 为女性；随访时间：7.6 ± 3.2 年）。 PwMS 的总体风险略有增加（HR 1.06，95% CI 1.03-1.08），主要发生在女性（HR 1.08，95% CI 1.05-1.11）。风险因癌症类型而异，前列腺癌（HR 0.80，95% CI 0.73-0.88）、乳腺癌（HR 0.91，95% CI 0.86-0.95）和结直肠癌（HR 0.90，95% CI 0.84-0.97）的风险较低。 PwMS 中膀胱癌（HR 1.71，95% CI 1.54-1.89）、脑癌（HR 1.68，95% CI 1.42-1.98）和宫颈癌（HR 1.24，95% CI 1.12-1.38）的风险较高。 55 岁以下的 PwMS 中癌症风险较高（HR 1.20，95% CI 1.15-1.24），但 65 岁及以上的 PwMS 中癌症风险降低（HR 0.89，95% CI 0.85-0.94）。在所有癌症部位都发现了这种趋势。接受 PwMS 筛查的人数少于对照组（所有项目），其中 65 岁及以上人群的差异尤其明显。PwMS 的癌症风险略有增加，特别是泌尿生殖系统癌症，可能是由于监测偏差所致。风险随年龄而波动，可能是由于不同代际的筛查做法（即较老的 PwMS 中的诊断忽视）和风险因素所致。

Previous literature has been diverging on cancer risk in people with multiple sclerosis (PwMS). Therefore, this study compared the risk of cancer in PwMS and a matched sample from the French general population.This 10-year nationwide retrospective matched cohort study (2012-2021) used data from the national French administrative health care database (99% coverage of the French population) to determine the time to the first incident cancer. PwMS were identified using their long-term disease (LTD) status, hospitalizations, and multiple sclerosis (MS)-specific drug reimbursements. The control population was matched 4:1 on age, sex, residence, insurance scheme, and cohort entry date. Participants were included if they had no history of cancer in the 3 years before inclusion. Patients with cancer were identified through LTD status, hospitalizations, chemotherapy, radiotherapy, or prostate cancer-specific drug reimbursements. Overall and cancer location-specific hazard ratios (HRs) for the first incident cancer were obtained from Fine and Gray models, and age- and sex-stratified estimates were reported. Participation in cancer screening through the 3 national programs (breast, colorectal, and cervical) were compared between groups.Cancer incidence was 799 per 100,000 person-years (PYs) (n = 8,368) among the 140,649 PwMS and 736 per 100,000 PYs (n = 31,796) among the 562,596 matched controls (70.8% of women; follow-up: 7.6 ± 3.2 years). A small overall risk increase was observed for PwMS (HR 1.06, 95% CI 1.03-1.08), mostly in women (HR 1.08, 95% CI 1.05-1.11). Risk varied by cancer types and was lower for prostate (HR 0.80, 95% CI 0.73-0.88), breast (HR 0.91, 95% CI 0.86-0.95), and colorectal (HR 0.90, 95% CI 0.84-0.97) cancer and higher for bladder (HR 1.71, 95% CI 1.54-1.89), brain (HR 1.68, 95% CI 1.42-1.98), and cervical (HR 1.24, 95% CI 1.12-1.38) cancer in PwMS. Cancer risk was higher in PwMS younger than 55 years (HR 1.20, 95% CI 1.15-1.24) but decreased in PwMS aged 65 years and older (HR 0.89, 95% CI 0.85-0.94). This trend was found in all cancer locations. There were fewer PwMS getting screened than controls (all programs), with a particularly pronounced difference among those aged 65 years and older.Cancer risk was slightly increased in PwMS, particularly for urogenital cancers, possibly due to surveillance bias. Risk fluctuated depending on age, perhaps due to varying generational screening practices (i.e., diagnosis neglect in the older PwMS) and risk factors.