2 型糖尿病患者的癌症发病率 - D2C 队列可行性研究的初步结果。
Cancer incidence in type 2 diabetes patients - first results from a feasibility study of the D2C cohort.
机构信息
Institute of Epidemiology and Social Medicine; Westphalian Wilhelms University, Domagk Str, 3, 48129 Münster, Germany.
出版信息
Diabetol Metab Syndr. 2011 Jul 13;3(1):15. doi: 10.1186/1758-5996-3-15.
BACKGROUND
A large prospective study in patients with type 2 diabetes (T2D), the German D2C cohort, is presently being enumerated to investigate risk factors of incident cancer in diabetic patients.
STUDY SETTING
A disease management program was offered, on a voluntary basis, to all T2D patients who were members of a statutory health insurance fund in Germany. This first feasibility report uses data from 26.742 T2D patients, who were 40 to 79 years old, resided in the Muenster District, and who were enrolled between June 2003 and July 2008. Cancer cases were identified through the regional Cancer Registry.
METHODS
Invasive cancer cases were identified using probabilistic record linkage procedures and pseudonymised personal identifiers. Censoring date was December 31, 2008. We included only first cancers, leaving 12.650 male and 14.092 female T2D with a total of 88.778 person-years (py). We computed standardised incidence ratios (SIR) for external comparisons and we employed Cox regression models and hazard ratios (HR) within the cohort.
RESULTS
We identified 759 first cancers among male T2D patients (18.7 per 1,000 py) and 605 among females (12.7 per 1,000 py). The risk of any incident cancer in T2D was raised (SIR = 1.14; 95% confidence interval [1.10 - 1.21]), in particular for cancer of the liver (SIR = 1.94 [1.15 - 2.94]) and pancreas (SIR = 1.45 [1.07-1.92]). SIRs decreased markedly with time after T2D diagnosis. In Cox models, adjusting for diabetes duration, body mass index and sex, insulin therapy was related to higher cancer risk (HR = 1.25 [1.17 - 1.33]). No effect was seen for metformin.
DISCUSSION
Our study demonstrates feasibility of record linkage between DMP and cancer registries. These first cohort results confirm previous reports. It is envisaged to enhance this cohort by inclusion of further regions of the state, expansion of the follow-up times, and collection of a more detailed medication history.
背景
目前正在对 2 型糖尿病（T2D）患者进行一项大型前瞻性研究——德国 D2C 队列研究，以调查糖尿病患者癌症发病的危险因素。
研究地点
该研究是一项疾病管理项目，在德国的一家法定健康保险公司中，所有 T2D 患者都可以自愿参加。本首次可行性报告使用了 2003 年 6 月至 2008 年 7 月期间登记的 26742 名年龄在 40 至 79 岁、居住在明斯特区的 T2D 患者的数据。癌症病例通过区域癌症登记处确定。
方法
使用概率记录链接程序和化名个人标识符确定侵袭性癌症病例。截止日期为 2008 年 12 月 31 日。我们仅纳入首例癌症，共有 12650 名男性和 14092 名女性 T2D 患者，总计 88778 人年（py）。我们计算了外部比较的标准化发病比（SIR），并在队列内使用 Cox 回归模型和风险比（HR）。
结果
我们在男性 T2D 患者中发现了 759 例首例癌症（1000py 中 18.7 例），在女性中发现了 605 例（1000py 中 12.7 例）。T2D 患者任何癌症的发病风险均升高（SIR=1.14；95%置信区间[1.10-1.21]），特别是肝癌（SIR=1.94[1.15-2.94]）和胰腺癌（SIR=1.45[1.07-1.92]）。T2D 诊断后，SIR 随时间显著下降。在 Cox 模型中，调整糖尿病病程、体重指数和性别后，胰岛素治疗与更高的癌症风险相关（HR=1.25[1.17-1.33]）。二甲双胍无此作用。
讨论
本研究证明了 DMP 与癌症登记处之间记录链接的可行性。这些首次队列研究结果证实了既往报告。预计通过纳入该州的其他地区、延长随访时间和收集更详细的用药史来增强该队列。
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