Chen Chun-Chao, Hsu Yi-Ping, Liu Ju-Chi, Kao Pai-Feng, Sung Li-Chin, Lin Chao-Feng, Hao Wen-Rui, Liu Shing-Hwa, Wu Szu-Yuan
Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
J Cancer. 2016 Sep 13;7(13):1892-1900. doi: 10.7150/jca.15779. eCollection 2016.
Chronic obstructive pulmonary disease (COPD) is associated with an increased cancer risk. We evaluated the chemopreventive effect of statins against all cancers in COPD patients and identified the statin with the strongest chemopreventive effect. : All patients diagnosed with COPD at health care facilities in Taiwan (n = 116,017) from January 1, 2001, to December 31, 2012, were recruited. Each patient was followed to assess the following protective and risk factors for all cancers: age; sex; comorbidities (diabetes, hypertension, dyslipidemia) and the Charlson comorbidity index [CCI]); urbanization level; monthly income; and nonstatin drug use. The index date of statins use was the date of COPD confirmation. Propensity scores (PSs) were derived using a logistic regression model to estimate the effect of statins by considering the covariates predicting intervention (statins) receipt. To examine the dose-response relationship, we categorized statin use into four groups in each cohort (<28 [statin nonusers], 28-90, 91-365, and >365 cumulative defined daily dose). After PS adjustment for age, sex, CCI, diabetes, hypertension, dyslipidemia, urbanization level, and monthly income, we analyzed the all-cancer risk. The adjusted hazard ratios (aHRs) for the all-cancer risk were lower among statin users than among statin nonusers (aHR = 0.46, 95% confidence interval: 0.43 to 0.50). The aHRs for the all-cancer risk were lower among patients using rosuvastatin, simvastatin, atorvastatin, pravastatin, and fluvastatin than among statin nonusers (aHRs = 0.42, 0.55, 0.59, 0.66, and 0.78, respectively). Sensitivity analysis indicated that statins dose-dependently reduced the all-cancer risk. Statins dose-dependently exert a significant chemopreventive effect against various cancers in COPD patients. In particular, rosuvastatin has the strongest chemopreventive effect.
慢性阻塞性肺疾病（COPD）与癌症风险增加相关。我们评估了他汀类药物对COPD患者所有癌症的化学预防作用，并确定了具有最强化学预防作用的他汀类药物。：招募了2001年1月1日至2012年12月31日期间在台湾医疗机构被诊断为COPD的所有患者（n = 116,017）。对每位患者进行随访，以评估以下所有癌症的保护因素和风险因素：年龄；性别；合并症（糖尿病、高血压、血脂异常）和查尔森合并症指数[CCI]）；城市化水平；月收入；以及非他汀类药物使用情况。他汀类药物使用的索引日期为COPD确诊日期。使用逻辑回归模型得出倾向评分（PSs），以通过考虑预测干预（他汀类药物）接受情况的协变量来估计他汀类药物的效果。为了研究剂量反应关系，我们在每个队列中将他汀类药物使用分为四组（<28[非他汀类药物使用者]、28 - 90、91 - 365和>365累积限定日剂量）。在对年龄、性别、CCI、糖尿病、高血压、血脂异常、城市化水平和月收入进行PS调整后，我们分析了所有癌症风险。他汀类药物使用者的所有癌症风险调整后危险比（aHRs）低于非他汀类药物使用者（aHR = 0.46，95%置信区间：0.43至0.50）。使用瑞舒伐他汀、辛伐他汀、阿托伐他汀、普伐他汀和氟伐他汀的患者的所有癌症风险aHRs低于非他汀类药物使用者（aHRs分别为0.42、0.55、0.59、0.66和0.78）。敏感性分析表明，他汀类药物剂量依赖性地降低了所有癌症风险。他汀类药物对COPD患者的各种癌症具有剂量依赖性的显著化学预防作用。特别是，瑞舒伐他汀具有最强化学预防作用。
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