Kok Victor C, Horng Jorng-Tzong, Huang Hsu-Kai, Chao Tsung-Ming, Hong Ya-Fang
Division of Medical Oncology, Department of Internal Medicine, Kuang Tien General Hospital, Taichung, Taiwan ; Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan.
Department of Biomedical Informatics, Asia University Taiwan, Taichung, Taiwan ; Department of Computer Science and Information Engineering, National Central University, Jhongli, Taiwan.
Ther Clin Risk Manag. 2015 Mar 26;11:489-99. doi: 10.2147/TCRM.S80793. eCollection 2015.
Recent studies have shown that inhaled corticosteroids (ICS) can exert anti-inflammatory effects for chronic airway diseases, and several observational studies suggest that they play a role as cancer chemopreventive agents, particularly against lung cancer. We aimed to examine whether regular ICS use was associated with a reduced risk for future malignancy in patients with newly diagnosed adult-onset asthma.
We used a population-based cohort study between 2001 and 2008 with appropriate person-time analysis. Participants were followed up until the first incident of cancer, death, or to the end of 2008. The Cox model was used to derive an adjusted hazard ratio (aHR) for cancer development. Kaplan-Meier cancer-free survival curves of two groups were compared.
The exposed group of 2,117 regular ICS users and the nonexposed group of 17,732 non-ICS users were assembled. After 7,365 (mean, 3.5 years; standard deviation 2.1) and 73,789 (mean, 4.1 years; standard deviation 2.4) person-years of follow-up for the ICS users and the comparator group of non-ICS users, respectively, the aHR for overall cancer was nonsignificantly elevated at 1.33 with 95% confidence interval (CI), 1.00-1.76, P=0.0501. The Kaplan-Meier curves for overall cancer-free proportions of both groups were not significant (log-rank, P=0.065). Synergistic interaction of concurrent presence of regular ICS use was conducted using "ICS-negative and chronic obstructive pulmonary disease (COPD)-negative" as the reference. The aHR for the group of "ICS-positive, COPD-negative" did not reach statistically significant levels with aHR at 1.38 (95% CI, 0.53-3.56). There was a statistically significant synergistic interaction of concurrent presence of regular ICS use and COPD with aHR at 3.78 (95% CI, 2.10-6.81).
The protective effect of regular ICS use in the studied East Asian patients with adult-onset asthma was not detectable, contrary to reports of previous studies that ICS might prevent the occurrence of future cancer.
近期研究表明，吸入性糖皮质激素（ICS）可对慢性气道疾病发挥抗炎作用，多项观察性研究表明，它们可作为癌症化学预防剂发挥作用，尤其是对肺癌。我们旨在研究在新诊断的成年发病哮喘患者中，规律使用ICS是否与未来患恶性肿瘤风险降低有关。
我们在2001年至2008年期间进行了一项基于人群的队列研究，并进行了适当的人时分析。对参与者进行随访，直至首次发生癌症、死亡或至2008年底。使用Cox模型得出癌症发生的调整风险比（aHR）。比较两组的Kaplan-Meier无癌生存曲线。
纳入了2117名规律使用ICS的暴露组和17732名未使用ICS的非暴露组。ICS使用者和非ICS使用者比较组分别经过7365人年（平均3.5年；标准差2.1）和73789人年（平均4.1年；标准差2.4）的随访后，总体癌症的aHR为1.33，95%置信区间（CI）为1.00-1.76，P=0.0501，无显著升高。两组总体无癌比例的Kaplan-Meier曲线无显著差异（对数秩检验，P=0.065）。以“未使用ICS且无慢性阻塞性肺疾病（COPD）”为参照，对规律使用ICS同时存在的协同相互作用进行分析。“使用ICS且无COPD”组的aHR为1.38（95%CI，0.53-3.56），未达到统计学显著水平。规律使用ICS与COPD同时存在存在统计学显著的协同相互作用，aHR为3.78（95%CI，2.10-6.81）。
在本研究的东亚成年发病哮喘患者中，未检测到规律使用ICS的保护作用，这与之前关于ICS可能预防未来癌症发生的研究报告相反。
