慢性阻塞性肺疾病（COPD）患者使用短效吸入性药物治疗会增加前列腺癌风险：一项两阶段数据库研究。
Chronic obstructive pulmonary disease with short-acting inhaled pharmacotherapy increases the risk of prostate cancer: A two-stage database approach.
机构信息
Department of Mathematics, Soochow University, Taipei, Taiwan.
Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
出版信息
PLoS One. 2018 Sep 6;13(9):e0203377. doi: 10.1371/journal.pone.0203377. eCollection 2018.
BACKGROUND
Patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of many types of cancer. However, specific investigation of the risk of prostate cancer and the influence of COPD pharmacotherapy in patients with COPD is lacking. This study investigated the risk and influence of COPD pharmacotherapy on risk of prostate cancer in patients with COPD.
METHODS
This retrospective cohort study used data from Taiwan's Longitudinal Health Insurance Database 2005 (LHID2005). The study cohort comprised COPD patients who received treatment between 2004 and 2008, and who were identified from the LHID2005. The control cohort comprised patients without COPD and was matched to the study cohort by age and sex. Two-stage propensity score calibration with the National Health Interview Survey 2005 was performed to obtain the missing confounders of smoking, alcohol drinking, and body mass index in the LHID. The hazard ratio (HR) and adjusted HR were estimated. Moreover, the influence of inhaled medications and other related medication on the risk of prostate cancer was analyzed by Cox proportional hazard regression.
RESULTS
The COPD cohort comprised 12,774 patients, and the control cohort comprised 38,322 patients (1:3). The incidence of prostate cancer was 633 per 100,000 person-years in the COPD cohort and 361 per 100,000 person-years in the control cohort. The propensity score calibration-adjusted HR was 1.62 (95% CI, 1.40-1.87, p < 0.001) in the COPD cohort. Further analysis revealed that the adjusted HR for the risk of prostate cancer was 1.61 (95% CI, 1.19-2.16, p = 0.002) in patients with COPD who used short-acting muscarinic antagonists (SAMAs) and 1.89 (95% CI, 1.40-2.54, p < 0.001) in patients with COPD who used short-acting beta-agonists (SABAs). COPD patients had lower risk of prostate cancer when using statin (HR = 0.63, 95% CI, 0.45-0.89, p = 0.010) or aspirin (HR = 0.55, 95% CI, 0.35-0.85, p = 0.008).
CONCLUSION
Patients with COPD are at a higher risk of prostate cancer, particularly those using SAMAs or SABAs. This finding suggests that inflammation control may be an effective strategy for decreasing the risk of prostate cancer.
背景
患有慢性阻塞性肺疾病（COPD）的患者患多种类型癌症的风险更高。然而，针对 COPD 患者前列腺癌的风险以及 COPD 药物治疗的影响的具体研究仍较为缺乏。本研究旨在探讨 COPD 患者中 COPD 药物治疗对前列腺癌风险的影响。
方法
本回顾性队列研究使用了来自台湾 2005 年纵向健康保险数据库（LHID2005）的数据。研究队列包括了 2004 年至 2008 年间接受治疗的 COPD 患者，并从 LHID2005 中确定。对照组由没有 COPD 的患者组成，并按年龄和性别与研究队列相匹配。采用 2005 年全国健康访谈调查的两阶段倾向评分校准来获取 LHID 中吸烟、饮酒和体重指数等缺失的混杂因素。估计了风险比（HR）和调整后的 HR。此外，还通过 Cox 比例风险回归分析了吸入药物和其他相关药物对前列腺癌风险的影响。
结果
COPD 队列包括 12774 名患者，对照组包括 38322 名患者（1:3）。COPD 队列的前列腺癌发病率为每 100000 人年 633 例，对照组为每 100000 人年 361 例。经过倾向评分校准调整后的 HR 在 COPD 队列中为 1.62（95%CI，1.40-1.87，p<0.001）。进一步分析显示，在使用短效毒蕈碱拮抗剂（SAMAs）的 COPD 患者中，前列腺癌风险的调整 HR 为 1.61（95%CI，1.19-2.16，p=0.002），在使用短效β-激动剂（SABAs）的 COPD 患者中为 1.89（95%CI，1.40-2.54，p<0.001）。COPD 患者使用他汀类药物（HR=0.63，95%CI，0.45-0.89，p=0.010）或阿司匹林（HR=0.55，95%CI，0.35-0.85，p=0.008）时患前列腺癌的风险较低。
结论
患有 COPD 的患者患前列腺癌的风险较高，尤其是使用 SAMAs 或 SABAs 的患者。这一发现表明，控制炎症可能是降低前列腺癌风险的有效策略。
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