Huang Hung-Yu, Shih-Wei Lin, Chuang Li-Pang, Wang Chih-Liang, Sun Ming-Hui, Li Hsueh-Yu, Chang Chee-Jen, Chang Shu-Chen, Yang Cheng-Ta, Chen Ning-Hung
Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital, Taoyuan, Taiwan.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
J Clin Sleep Med. 2020 Mar 24. doi: jc-19-00502.
Obstructive sleep apnea (OSA) has been associated with increased cancer incidence and mortality. The aim of this study was to investigate cancer-related mortality, overall survival and progression free survival in patients with suspected OSA and lung cancer.
This was a case series analysis of lung cancer from a sleep cohort with suspected OSA between 2009 and 2014. The apnea- hypopnea index (AHI), Tsat90% (hypoxia index) and survival outcome were recorded. Immunohistochemistry was used to analyze HIF-1α and VEGF expression in tumor pathology.
In the sleep cohort comprising 8261 patients, a total of 23 patients had lung cancer. The incidence of lung cancer was significantly higher in the sleep cohort than in the entire adult population in Taiwan (242.1 vs 51.5 per 10⁵ persons, P< 0.01). The 3-year cancer-related mortality was 25% in AHI < 15, 50% in AHI 15 to 29 and 80% in AHI ≥ 30 (chi-squared test for trend P =0.03). In Kaplan-Meier survival analysis, patients with stage III-IV lung cancer and AHI< 30 exhibited significantly better overall survival (P = 0.02) and progression free survival (P = 0.02) than patients with severe OSA. Overexpression of HIF-1α and VEGF was shown in 63 % and 45 % of lung tumor samples. Overexpression of HIF-1α was positively associated with AHI (P = 0.04).
In this preliminary case series, severe OSA is associated with an increased risk of cancer mortality in patients with stage III-IV lung cancer. AHI was significantly associated with HIF-1α overexpression.
阻塞性睡眠呼吸暂停（OSA）与癌症发病率和死亡率的增加有关。本研究的目的是调查疑似OSA和肺癌患者的癌症相关死亡率、总生存期和无进展生存期。
这是一项对2009年至2014年间疑似OSA的睡眠队列中的肺癌进行的病例系列分析。记录呼吸暂停低通气指数（AHI）、Tsat90%（低氧指数）和生存结果。采用免疫组织化学分析肿瘤病理学中HIF-1α和VEGF的表达。
在包含8261名患者的睡眠队列中，共有23名患者患有肺癌。睡眠队列中肺癌的发病率显著高于台湾全体成年人群（每10⁵人中有242.1例 vs 51.5例，P<0.01）。AHI<15时3年癌症相关死亡率为25%，AHI为15至29时为50%，AHI≥30时为80%（趋势卡方检验P =0.03）。在Kaplan-Meier生存分析中，III-IV期肺癌且AHI<30的患者的总生存期（P =0.02）和无进展生存期（P =0.02）显著优于重度OSA患者。63%的肺肿瘤样本中显示HIF-1α过表达，45%的样本中显示VEGF过表达。HIF-1α过表达与AHI呈正相关（P =0.04）。
在这个初步的病例系列中，重度OSA与III-IV期肺癌患者的癌症死亡风险增加有关。AHI与HIF-1α过表达显著相关。
