Tagalakis Vicky, Tamim Hani, Blostein Mark, Collet Jean-Paul, Hanley James A, Kahn Susan R
Centre for Clinical Epidemiology and Community Studies, SMBD-Jewish General Hospital, Montréal, QC, Canada.
Lancet Oncol. 2007 May;8(5):395-402. doi: 10.1016/S1470-2045(07)70046-3.
Indirect evidence suggests that prolonged treatment with warfarin might be associated with a decreased incidence of urogenital cancer. We aimed to assess this association in a large population-based study.
Beneficiaries of Saskatchewan Health who were eligible for prescription drug benefits and aged 50 years or over with no history of cancer since 1967 were enrolled into a nested, matched case-control study. 19 412 new cases of urogenital cancer diagnosed between Jan 1, 1981, and Dec 31, 2002, were identified by use of information from the Saskatchewan Cancer Agency registry. For each case, six controls, totalling 116 470, who were matched for age, sex, and time of diagnosis were selected randomly. Conditional logistic regression analysis was used to calculate adjusted incidence rates of urogenital cancer in relation to warfarin use.
Compared with men who never used warfarin, men with 4 years of warfarin use had an adjusted incidence rate of 0.80 (95% CI [0.65-0.99]). For warfarin use 76-100% of the time, the adjusted rate ratios were 0.80 (0.66-0.96) during year 2 preceding diagnosis of prostate cancer, 0.76 (0.62-0.94) during year 3, and 0.67 (0.53-0.86) during year 4. No significant association was found between warfarin and risk of other urogenital cancers.
Our results suggest that warfarin has an antitumour effect that is specific to prostate cancer. Further investigation, with more complete assessment of confounders and that addresses the effect of warfarin on mortality of prostate cancer, is warranted.
间接证据表明，长期使用华法林可能与泌尿生殖系统癌症发病率降低有关。我们旨在通过一项大型基于人群的研究评估这种关联。
萨斯喀彻温省健康保险计划的受益人群，即有资格享受处方药福利且年龄在50岁及以上、自1967年以来无癌症病史者，被纳入一项嵌套式匹配病例对照研究。利用萨斯喀彻温省癌症机构登记处的信息，确定了1981年1月1日至2002年12月31日期间诊断出的19412例泌尿生殖系统癌症新病例。对于每例病例，随机选择6名对照，共计116470名，按年龄、性别和诊断时间进行匹配。采用条件逻辑回归分析计算与华法林使用相关的泌尿生殖系统癌症调整发病率。
与从未使用过华法林的男性相比，使用华法林4年的男性调整发病率为0.80（95%可信区间[0.65 - 0.99]）。在前列腺癌诊断前第2年，华法林使用时间占76% - 100%时，调整率比为0.80（0.66 - 0.96）；第3年为0.76（0.62 - 0.94）；第4年为0.67（0.53 - 0.86）。未发现华法林与其他泌尿生殖系统癌症风险之间存在显著关联。
我们的结果表明，华法林对前列腺癌具有特异性抗肿瘤作用。有必要进行进一步研究，更全面地评估混杂因素，并探讨华法林对前列腺癌死亡率的影响。
