Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Radiother Oncol. 2012 Sep;104(3):338-42. doi: 10.1016/j.radonc.2012.08.015. Epub 2012 Sep 14.
To determine whether the diagnosis of otitis media (OM) in adults is associated with an increased risk for the subsequent development of nasopharyngeal cancer (NPC) using a nationwide population-based retrospective study.
We selected 13,513 adult patients that had been previously diagnosed with OM between 2000 and 2005 from the Taiwan Longitudinal Health Insurance Database 2000 as the study cohort, and randomly extracted the data of 135,130 participants matched by sex, age, and baseline year for the comparison cohort. The follow-up period was terminated upon developing NPC, withdrawal from the national health insurance system, or the end of 2009. Cumulative incidences and hazard ratios (HRs) of NPC development were determined.
The subsequent NPC incidence rates in the OM and comparison cohorts were 6.41 and 0.58 per 10000 person-years, respectively (adjusted HR, 11.04; 95% CI, 7.68-5.87; P<0.0001). The NPC risk for males was significantly higher than that for females (adjusted HR=3.24; 95% CI, 2.16-4.85). In both female and male patients, the diagnosis of OM was associated with a significantly increased risk for NPC (adjusted HR, 11.91 vs. 10.78, respectively). Among the OM cohort, 62 participants were subsequently diagnosed with NPC, with 71% of them occurring within 1 year following the diagnosis of OM. However, even after 5-year follow-up, the OM cohort still displayed a higher risk for NPC (adjusted HR=2.50). Stratified by the frequency of OM episodes, more than one episode per year had a significantly greater risk of developing NPC, compared with the comparison cohort (HR=29.22; 95% CI, 20.19-42.27).
We found that adult OM is a warning sign for the development of NPC in Taiwan, with approximately an 11-fold higher risk for adult OM patients. We recommend that OM patients undergo follow-up examinations for at least 5 years. To extrapolate our findings, further studies are warranted in other areas in which NPC is endemic.
通过全国性基于人群的回顾性研究，确定成人中耳炎（OM）的诊断是否与随后发生鼻咽癌（NPC）的风险增加相关。
我们从台湾纵向健康保险数据库 2000 中选择了 2000 年至 2005 年间此前被诊断为 OM 的 13513 名成年患者作为研究队列，并随机抽取了性别、年龄和基线年份相匹配的 135130 名参与者的数据作为对照队列。随访期截止于发生 NPC、退出国民健康保险制度或 2009 年底。确定 NPC 发展的累积发生率和风险比（HR）。
OM 和对照队列的随后 NPC 发病率分别为 6.41 和 0.58/10000 人年（调整 HR，11.04；95%CI，7.68-5.87；P<0.0001）。男性的 NPC 风险明显高于女性（调整 HR=3.24；95%CI，2.16-4.85）。在女性和男性患者中，OM 的诊断均与 NPC 的风险显著增加相关（调整 HR，11.91 与 10.78，分别）。在 OM 队列中，有 62 名患者随后被诊断为 NPC，其中 71%的患者在 OM 诊断后 1 年内发生。然而，即使在 5 年随访后，OM 队列仍显示出 NPC 的风险较高（调整 HR=2.50）。按 OM 发作频率分层，每年发作一次以上的患者发生 NPC 的风险明显高于对照队列（HR=29.22；95%CI，20.19-42.27）。
我们发现台湾成年人 OM 是 NPC 发展的一个警告信号，成人 OM 患者的风险增加约 11 倍。我们建议 OM 患者至少随访 5 年。为了推断我们的发现，需要在 NPC 流行地区进行进一步的研究。
