Chen Hua-Fen, Chen Shwe-Winn, Chang Ya-Hui, Li Chung-Yi
From the Department of Endocrinology, Far Eastern Memorial Hospital (H-FC); School of Medicine, Fujen Catholic University (H-FC); Department of Nephrology, Central Hospital Group, New Taipei City (S-WC); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City (Y-HC, C-YL); and Department of Public Health, College of Public Health, China Medical University, Taichung City, Taiwan (C-YL).
Medicine (Baltimore). 2015 Sep;94(38):e1494. doi: 10.1097/MD.0000000000001494.
Diabetes has been reported to increase the risk of malignant neoplasms of kidney and bladder, but the studies' results are still inconclusive. Age, sex, and geographical area-specific incidence and relative risks of above neoplasms are also scarce in the literature. We prospectively investigated the age, sex, geographical area-specific incidence and relative risks of kidney and bladder neoplasms in diabetic population of Taiwan. Diabetic patients (n = 615,532) and age- and sex-matched controls (n = 614,871) were linked to inpatient claims (2000-2008) to identify the admissions for malignant neoplasm of kidney (International Classification of Diagnosis, 9th version, Clinical Modification: 189) and bladder (International Classification of Diagnosis, 9th version, Clinical Modification: 188). The person-year approach with Poisson assumption was used to evaluate the incidence density. We also estimated the age, sex, and geographical area-specific relative risks of above malignancy in relation to diabetes with Cox proportional hazard regression model. The overall incidence density of malignant neoplasm of kidney for diabetic men and women were 3.87 and 4.28 per 10,000 patient-years, respectively; the corresponding figures for malignant neoplasm of bladder were 5.73 and 3.25 per 10,000 patient-years. Compared with the controls, diabetic men were at significantly increased hazards of kidney (covariate adjusted hazard ratio [aHR]: 1.31, 95% confidence interval [CI] 1.18-1.46) and bladder aHR: 1.13, 95% CI 1.04-1.23). Diabetic women, on the contrary, only experienced significantly elevated hazard of kidney neoplasm (aHR: 1.14, 95% CI 1.04-1.26). Diabetic men aged >65 years showed the most significantly increased hazard of developing neoplasm of kidney (aHR: 1.40) and bladder (aHR: 1.13). The most significantly increased hazard of kidney neoplasm was noted for women diabetic patients aged >65 years. There was also a significant interactive effect of geographic area with diabetes on the incidence of kidney and bladder neoplasms in both sexes. Diabetic men >45 years and diabetic women >65 years were found to have significantly increased hazard of malignant neoplasm of kidney, but only diabetic men >65 years were at significantly increased hazard of bladder neoplasm. The significant geographic variations in incidence and relative hazard of kidney and bladder neoplasms warrant further investigations of the underlying reasons.
据报道，糖尿病会增加患肾癌和膀胱癌的风险，但研究结果仍无定论。关于上述肿瘤的年龄、性别和特定地理区域的发病率及相对风险，文献中也很缺乏。我们前瞻性地调查了台湾糖尿病患者中肾癌和膀胱癌的年龄、性别、特定地理区域的发病率及相对风险。将糖尿病患者（n = 615,532）和年龄及性别匹配的对照组（n = 614,871）与住院病历（2000 - 2008年）进行关联，以确定肾癌（国际疾病分类第9版临床修订本：189）和膀胱癌（国际疾病分类第9版临床修订本：188）的入院病例。采用基于泊松假设的人年法来评估发病密度。我们还使用Cox比例风险回归模型估计了上述恶性肿瘤相对于糖尿病的年龄、性别和特定地理区域的相对风险。糖尿病男性和女性肾癌的总体发病密度分别为每10,000患者年3.87例和4.28例；膀胱癌的相应数字分别为每10,000患者年5.73例和3.25例。与对照组相比，糖尿病男性患肾癌（协变量调整风险比[aHR]：1.31，95%置信区间[CI] 1.18 - 1.46）和膀胱癌（aHR：1.13，95% CI 1.04 - 1.23）的风险显著增加。相反，糖尿病女性仅患肾癌的风险显著升高（aHR：1.14，95% CI 1.04 - 1.26）。年龄>65岁的糖尿病男性患肾癌（aHR：1.40）和膀胱癌（aHR：1.13）的风险增加最为显著。年龄>65岁的糖尿病女性患肾癌的风险增加最为显著。地理区域与糖尿病对男性和女性肾癌及膀胱癌的发病率也有显著的交互作用。发现年龄>45岁的糖尿病男性和年龄>65岁的糖尿病女性患肾癌的风险显著增加，但只有年龄>65岁的糖尿病男性患膀胱癌的风险显著增加。肾癌和膀胱癌发病率及相对风险的显著地理差异值得进一步研究其潜在原因。
