Sun Li-Min, Wu Jung-Nan, Lin Cheng-Li, Day Jen-Der, Liang Ji-An, Liou Li-Ren, Kao Chia-Hung
From the Department of Radiation Oncology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung (L-MS); General Affairs Office, China Medical University Hospital, Taichung (J-NW); Department of Industrial Engineering and Management, National Kaohsiung University of Applied Sciences, Kaohsiung (J-NW, J-DD); Management Office for Health Data, China Medical University Hospital (C-LL); College of Medicine (C-LL); Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung (J-AL, C-HK); Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung (L-RL); Department of Radiation Oncology (J-AL); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK).
Medicine (Baltimore). 2016 Mar;95(12):e3198. doi: 10.1097/MD.0000000000003198.
This study investigated the possible relationship between endocarditis and overall and individual cancer risk among study participants in Taiwan.We used data from the National Health Insurance program of Taiwan to conduct a population-based, observational, and retrospective cohort study. The case group consisted of 14,534 patients who were diagnosed with endocarditis between January 1, 2000 and December 31, 2010. For the control group, 4 patients without endocarditis were frequency matched to each endocarditis patient according to age, sex, and index year. Competing risks regression analysis was conducted to determine the effect of endocarditis on cancer risk.A large difference was noted in Charlson comorbidity index between endocarditis and nonendocarditis patients. In patients with endocarditis, the risk for developing overall cancer was significant and 119% higher than in patients without endocarditis (adjusted subhazard ratio = 2.19, 95% confidence interval = 1.98-2.42). Regarding individual cancers, in addition to head and neck, uterus, female breast and hematological malignancies, the risks of developing colorectal cancer, and some digestive tract cancers were significantly higher. Additional analyses determined that the association of cancer with endocarditis is stronger within the 1st 5 years after endocarditis diagnosis.This population-based cohort study found that patients with endocarditis are at a higher risk for colorectal cancer and other cancers in Taiwan. The risk was even higher within the 1st 5 years after endocarditis diagnosis. It suggested that endocarditis is an early marker of colorectal cancer and other cancers. The underlying mechanisms must still be explored and may account for a shared risk factor of infection in both endocarditis and malignancy.
本研究调查了台湾地区研究参与者中心内膜炎与总体及个体癌症风险之间的潜在关系。我们利用台湾地区国民健康保险计划的数据进行了一项基于人群的观察性回顾性队列研究。病例组由2000年1月1日至2010年12月31日期间被诊断为心内膜炎的14534名患者组成。对于对照组，根据年龄、性别和索引年份，每例心内膜炎患者与4例无心内膜炎患者进行频数匹配。进行竞争风险回归分析以确定心内膜炎对癌症风险的影响。心内膜炎患者与无心内膜炎患者的Charlson合并症指数存在显著差异。在心内膜炎患者中，发生总体癌症的风险显著高于无心内膜炎患者，高出119%（调整后亚风险比=2.19，95%置信区间=1.98 - 2.42）。对于个体癌症，除头颈部、子宫、女性乳腺和血液系统恶性肿瘤外，患结直肠癌和一些消化道癌症的风险也显著更高。进一步分析确定，癌症与心内膜炎的关联在诊断心内膜炎后的前5年内更强。这项基于人群的队列研究发现，台湾地区的心内膜炎患者患结直肠癌和其他癌症的风险更高。在心内膜炎诊断后的前5年内风险甚至更高。这表明心内膜炎是结直肠癌和其他癌症的早期标志物。其潜在机制仍有待探索，可能是心内膜炎和恶性肿瘤共有的感染风险因素。
