糖尿病患者患皮肤癌的风险：台湾一项全国性回顾性队列研究
Risk of skin cancer in patients with diabetes mellitus: A nationwide retrospective cohort study in Taiwan.
作者信息
Tseng Hui-Wen, Shiue Yow-Ling, Tsai Kuo-Wang, Huang Wei-Chun, Tang Pei-Ling, Lam Hing-Chung
机构信息
aDepartment of Dermatology, Kaohsiung Veterans General Hospital bInstitute of Biomedical Sciences, National Sun Yat-Sen University cDepartment of Medical Education and Research dCritical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung eSchool of Medicine, National Yang-Ming University, Taipei fDepartment of Physical Therapy, Fooyin University gCenter for Geriatrics and Gerontology hDivision of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
出版信息
Medicine (Baltimore). 2016 Jun;95(26):e4070. doi: 10.1097/MD.0000000000004070.
Increasing evidence suggests that certain types of cancers are more common in people with diabetes mellitus (DM). This study aimed to investigate the risk of skin cancer in patients with DM in Taiwan. In this retrospective cohort study using data from the Taiwan Longitudinal Health Insurance Research Database, the risk of developing overall skin cancer, including nonmelanoma skin cancer (NMSC) and melanoma, was compared by Poisson regression analysis and Cox regression analysis between the DM and non-DM cohorts. The DM cohort with newly diagnosed DM (n = 41,898) and a non-DM cohort were one-to-one matched by age, sex, index date, and comorbidities (coronary artery disease, hyperlipidemia, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and obesity). Compared with non-DM cohort statistically, for the people with DM aged ≥60 years, the incidence rates of overall skin cancer and NMSC were significantly higher (overall: DM/non-DM: number [n] = 99/76, incidence rate ratio [IRR] = 1.44, P = 0.02; NMSC: DM/non-DM: n = 94/66, IRR = 1.57, P = 0.005). By Cox regression analysis, the risk of developing overall skin cancer or NMSC was significantly higher after adjusting for sex, comorbidities, and overall diseases with immunosuppression status (overall: adjusted hazard ratio [AHR] = 1.46, P = 0.01; NMSC: AHR = 1.6, P = 0.003). Other significant risk factors were older males for skin cancer (overall: AHR = 1.68, P = 0.001; NMSC: AHR = 1.59, P = 0.004; melanoma: AHR = 3.25, P = 0.04), chronic obstructive pulmonary disease for NMSC (AHR = 1.44, P = 0.04), and coronary artery disease for melanoma (AHR = 4.22, P = 0.01). The risk of developing melanoma was lower in the DM cohort than in the non-DM cohort, but without significance (AHR = 0.56, P = 0.28; DM/non-DM: n = 5/10). The incidence rate and risk of developing overall skin cancer, including NMSC, was significantly higher in older adults with DM. Other significant risk factors for older adults with DM were males for NMSC and melanoma, chronic obstructive pulmonary disease for NMSC, and coronary artery disease for melanoma.
越来越多的证据表明，某些类型的癌症在糖尿病（DM）患者中更为常见。本研究旨在调查台湾DM患者患皮肤癌的风险。在这项回顾性队列研究中，使用台湾纵向健康保险研究数据库的数据，通过泊松回归分析和Cox回归分析比较了DM队列和非DM队列中发生总体皮肤癌（包括非黑素瘤皮肤癌（NMSC）和黑色素瘤）的风险。新诊断为DM的DM队列（n = 41,898）和非DM队列按年龄、性别、索引日期和合并症（冠状动脉疾病、高脂血症、高血压、慢性肾病、慢性阻塞性肺疾病和肥胖症）进行一对一匹配。与非DM队列相比，在统计学上，对于年龄≥60岁的DM患者，总体皮肤癌和NMSC的发病率显著更高（总体：DM/非DM：数量[n]=99/76，发病率比[IRR]=1.44，P = 0.02；NMSC：DM/非DM：n = 94/66，IRR = 1.57，P = 0.005）。通过Cox回归分析，在调整性别、合并症和具有免疫抑制状态的总体疾病后，发生总体皮肤癌或NMSC的风险显著更高（总体：调整后危险比[AHR]=1.46，P = 0.01；NMSC：AHR = 1.6，P = 0.003）。其他显著的危险因素是老年男性患皮肤癌（总体：AHR = 1.68，P = 0.001；NMSC：AHR = 1.59，P = 0.004；黑色素瘤：AHR = 3.25，P = 0.04）、慢性阻塞性肺疾病患NMSC（AHR = 1.44，P = 0.04）以及冠状动脉疾病患黑色素瘤（AHR = 4.22，P = 0.01）。DM队列中发生黑色素瘤的风险低于非DM队列，但无显著性差异（AHR = 0.56，P = 0.28；DM/非DM：n = 5/10）。患有DM的老年人发生总体皮肤癌（包括NMSC）的发病率和风险显著更高。患有DM的老年人的其他显著危险因素是男性患NMSC和黑色素瘤、慢性阻塞性肺疾病患NMSC以及冠状动脉疾病患黑色素瘤。
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