Wu Shih-Chi, Chen William Tzu-Liang, Muo Chih-Hsin, Sung Fung-Chang
Trauma and Emergency Center, China Medical University Hospital, Taichung 404, Taiwan; College of Medicine, China Medical University, Taichung 404, Taiwan.
College of Medicine, China Medical University, Taichung 404, Taiwan; Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung 404, Taiwan.
PLoS One. 2015 Apr 27;10(4):e0122725. doi: 10.1371/journal.pone.0122725. eCollection 2015.
BACKGROUND & AIMS: Cancer risk after appendectomy in patients with appendicitis remains unclear. This study examined the role of appendicitis as an early manifestation harbingering the distant malignancy.
From the insurance claims data of Taiwan, we identified a cohort of 130,374 patients newly received appendectomy from 2000-2009, without cancer diagnosis. A comparison cohort of 260,746 persons without appendectomy and cancer was selected from the same database, frequency matched by age, sex, comorbidity and index year. We monitored subsequent cancers with a12-month follow-up.
Over all, 1406 and 616 cancer cases were identified in the appendectomy cohort and comparisons, respectively, with all cancers incidence rate 4.64-fold higher in the appendectomy cohort (9.06 vs. 1.96 per 1000 person-months). Digestive and female genital organs harbored 80.9% of cancer cases in the appendectomy cohort. The Cox model measured site-specific hazard ratio (HR) was the highest for female genital cancers (23.3), followed by cancers of colorectum (14.7), small intestine (10.1), pancreas (7.40), lymphoma (5.89) and urinary system (4.50), all significant at 0.001 level. The HR of all cancers decreased from 13.7 within 3 months after appendectomy to 1.37 in 7-12 months after the surgery. In general, relative to the comparison cohort, younger appendectomy patients tended to have a higher HR than older patients.
The high incident cancers identified soon after appendectomy suggest the acute appendicitis is the early sign of distant metastatic malignancy. The risk of colorectal cancer, female genital cancer and haemopoietic malignancy deserve attention.
阑尾炎患者阑尾切除术后的癌症风险仍不明确。本研究探讨了阑尾炎作为远处恶性肿瘤早期表现的作用。
从台湾的保险理赔数据中，我们确定了一组2000年至2009年新接受阑尾切除术且无癌症诊断的130374例患者。从同一数据库中选择了一个由260746名未接受阑尾切除术且无癌症的人组成的对照队列，按年龄、性别、合并症和索引年份进行频率匹配。我们对后续癌症进行了为期12个月的随访。
总体而言，阑尾切除队列和对照组分别确诊了1406例和616例癌症病例，阑尾切除队列中所有癌症的发病率比对照组高4.64倍（每1000人月9.06例 vs. 1.96例）。阑尾切除队列中80.9%的癌症病例发生在消化器官和女性生殖器官。Cox模型测量的特定部位风险比（HR）在女性生殖系统癌症中最高（23.3），其次是结直肠癌（14.7）、小肠癌（10.1）、胰腺癌（7.40）、淋巴瘤（5.89）和泌尿系统癌症（4.50），所有这些在0.001水平均具有显著性。所有癌症的HR从阑尾切除术后3个月内的13.7降至术后7至12个月的1.37。一般来说，相对于对照队列，年轻的阑尾切除患者的HR往往比老年患者更高。
阑尾切除术后不久发现的高发病率癌症表明急性阑尾炎是远处转移性恶性肿瘤的早期迹象。结直肠癌、女性生殖系统癌症和血液系统恶性肿瘤的风险值得关注。
