Division of Primary Care, University Park, Nottingham NG2 7RD, UK.
BMJ. 2013 Jan 16;346:f114. doi: 10.1136/bmj.f114.
To investigate the association between use of bisphosphonates estimated from prescription information and risk of gastrointestinal cancers.
Series of nested case-control studies.
General practices in the United Kingdom contributing to the QResearch primary care database (660) and the Clinical Practice Research Datalink (CPRD) (643).
Patients aged ≥ 50 with a diagnosis of a primary gastrointestinal cancer in 1997-2011, each matched with up to five controls by age, sex, practice, and calendar year.
Odds ratios for incident gastrointestinal cancers (colorectal, oesophageal, gastric) and use of bisphosphonates, adjusted for smoking status, ethnicity, comorbidities, and use of other drugs.
20,106 and 19,035 cases of colorectal cancer cases, 5364 and 5135 cases of oesophageal cancer cases, and 3155 and 3157 cases of gastric cancer were identified from QResearch and CPRD, respectively. Overall bisphosphonate use (at least one prescription) was not associated with risk of colorectal, oesophageal, or gastric cancers in either database. Adjusted odds ratios (95% confidence interval) for QResearch and CPRD were 0.97 (0.79 to 1.18) and 1.18 (0.97 to 1.43) for oesophageal cancer; 1.12 (0.87 to 1.44) and 0.79 (0.62 to 1.01) for gastric cancer; and 1.03 (0.94 to 1.14) and 1.10 (1.00 to 1.22) for colorectal cancer. Additional analyses showed no difference between types of bisphosphonate for risk of oesophageal and colorectal cancers. For gastric cancer, alendronate use was associated with an increased risk (1.47, 1.11 to 1.95; P=0.008), but only in data from the QResearch database and without any association with duration and with no definitive confirmation from sensitivity analysis.
In this series of population based case-control studies in two large primary care databases, exposure to bisphosphonates was not associated with an increased risk of common gastrointestinal cancers.
研究根据处方信息估计的双膦酸盐使用与胃肠道癌症风险之间的关联。
一系列嵌套病例对照研究。
英国参与 QResearch 初级保健数据库（660）和临床实践研究数据链接（CPRD）（643）的常规做法。
1997 年至 2011 年间诊断为原发性胃肠道癌症的年龄≥50 岁的患者，每位患者按年龄、性别、实践和日历年与最多 5 名对照匹配。
新发胃肠道癌症（结直肠、食管、胃）的比值比和双膦酸盐的使用，调整了吸烟状况、种族、合并症和其他药物的使用。
从 QResearch 和 CPRD 中分别确定了 20,106 例和 19,035 例结直肠癌病例、5364 例和 5135 例食管癌病例以及 3155 例和 3157 例胃癌病例。总体而言，双膦酸盐的使用（至少一种处方）与 QResearch 和 CPRD 数据库中结直肠癌、食管癌或胃癌的风险无关。调整后的比值比（95%置信区间）为 QResearch 和 CPRD 分别为 0.97（0.79 至 1.18）和 1.18（0.97 至 1.43）食管癌；1.12（0.87 至 1.44）和 0.79（0.62 至 1.01）胃癌；1.03（0.94 至 1.14）和 1.10（1.00 至 1.22）结直肠癌。进一步的分析表明，不同类型的双膦酸盐在食管癌和结直肠癌的风险方面没有差异。对于胃癌，阿伦膦酸盐的使用与风险增加相关（1.47，1.11 至 1.95；P=0.008），但仅在 QResearch 数据库的数据中，且与持续时间无关，且敏感性分析未给出明确确认。
在这两项大型初级保健数据库中的一系列基于人群的病例对照研究中，双膦酸盐的暴露与常见胃肠道癌症的风险增加无关。
