McBeth John, Silman Alan J, Macfarlane Gary J
Unit of Epidemiology, The Medical School, University of Manchester, Manchester, UK.
Arthritis Rheum. 2003 Jun;48(6):1686-92. doi: 10.1002/art.10973.
To determine whether reported widespread body pain is related to an increased incidence of cancer and/or reduced survival from cancer, since our previous population surveys have demonstrated a relationship between widespread body pain and a subsequent 2-fold increase in mortality from cancer over an 8-year period.
A total of 6565 subjects in Northwest England participated in 2 health surveys during 1991-1992. The subjects were classified according to their reported pain status (no pain, regional pain, and widespread pain), and were subsequently followed up prospectively until December 31, 1999. During followup, information was collected on incidence of cancer and survival rates among those developing cancer. Associations between the original pain status and development of cancer and cancer survival were expressed as the incidence rate ratio (IRR) and mortality rate ratio (MRR), respectively. All analyses were adjusted for age, sex, and study location, the latter being a proxy measure of socioeconomic status.
Among the study population, 6331 had never been diagnosed with cancer at the time of participation in the survey. Of these subjects, 956 (15%) were classified as having widespread pain, 3061 (48%) as having regional pain, and 2314 (37%) as having no pain. There were a total of 395 first malignancies recorded during followup. In comparison with subjects reporting no pain, those with regional pain (IRR 1.19, 95% confidence interval [95% CI] 0.94-1.50) and widespread pain (IRR 1.61, 95% CI 1.21-2.13) experienced an excess incidence of cancer during the followup period. The increased incidence among subjects previously reporting widespread pain was related, most strongly, to breast cancer (IRR 3.67, 95% CI 1.39-9.68), but there were also cancers of the prostate (IRR 3.46, 95% CI 1.25-9.59), large bowel (IRR 2.35, 95% CI 0.96-5.77), and lung (IRR 2.04, 95% CI 0.96-4.34). Subjects reporting widespread pain who subsequently developed cancer, in comparison with those previously reporting no pain, had an increased risk of death (MRR 1.82, 95% CI 1.18-2.80). This decreased survival was highest among subjects with cancers of the breast and prostate, although the effects on site-specific survival were nonsignificant.
This study has demonstrated that widespread pain reported in population surveys is associated with a substantial subsequent increased incidence of cancer and reduced cancer survival. At present there are no satisfactory biologic explanations for this observation, although several possible leads have been identified.
鉴于我们之前的人群调查显示，广泛性身体疼痛与随后8年癌症死亡率增加两倍之间存在关联，本研究旨在确定报告的广泛性身体疼痛是否与癌症发病率增加和/或癌症生存率降低有关。
1991年至1992年期间，英格兰西北部共有6565名受试者参与了两项健康调查。根据他们报告的疼痛状况（无疼痛、局部疼痛和广泛性疼痛）对受试者进行分类，随后对其进行前瞻性随访，直至1999年12月31日。在随访期间，收集了癌症发病率和患癌者的生存率信息。最初的疼痛状况与癌症发生和癌症生存之间的关联分别表示为发病率比（IRR）和死亡率比（MRR）。所有分析均根据年龄、性别和研究地点进行了调整，后者是社会经济地位的替代指标。
在研究人群中，6331名受试者在参与调查时从未被诊断患有癌症。在这些受试者中，956名（15%）被分类为患有广泛性疼痛，3061名（48%）为患有局部疼痛，2314名（37%）为无疼痛。随访期间共记录了395例原发性恶性肿瘤。与报告无疼痛的受试者相比，患有局部疼痛（IRR 1.19，95%置信区间[95%CI]0.94 - 1.50）和广泛性疼痛（IRR 1.61，95%CI 1.21 - 2.13）的受试者在随访期间癌症发病率过高。先前报告有广泛性疼痛的受试者中发病率增加最显著的是乳腺癌（IRR 3.67，95%CI 1.39 - 9.68），但前列腺癌（IRR 3.46，95%CI 1.25 - 9.59）、大肠癌（IRR 2.35，95%CI 0.96 - 5.77）和肺癌（IRR 2.04，95%CI 0.96 - 4.34）也有增加。与先前报告无疼痛的受试者相比，报告有广泛性疼痛且随后患癌的受试者死亡风险增加（MRR 1.82，95%CI 1.18 - 2.80）。这种生存率降低在乳腺癌和前列腺癌患者中最高，尽管对特定部位生存的影响不显著。
本研究表明，人群调查中报告的广泛性疼痛与随后癌症发病率大幅增加和癌症生存率降低有关。目前，对于这一观察结果尚无令人满意的生物学解释，尽管已经确定了几个可能的线索。
