选择性5-羟色胺再摄取抑制剂（SSRIs）的使用与膀胱癌风险之间的关联：一项基于全国人口的队列研究。
The Association between Selective Serotonin Reuptake Inhibitors (SSRIs) Use and the Risk of Bladder Cancer: A Nationwide Population-Based Cohort Study.
作者信息
Liu Yi-Chun, Chen Vincent Chin-Hung, Lu Mong-Liang, Lee Min-Jing, McIntyre Roger S, Majeed Amna, Lee Yena, Chen Yi-Lung
机构信息
Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan.
School of Medicine, Chang Gung University, Tauyuan 33302, Taiwan.
出版信息
Cancers (Basel). 2020 May 7;12(5):1184. doi: 10.3390/cancers12051184.
BACKGROUND
Past studies suggest mixed associations between selective serotonin reuptake inhibitor (SSRI) prescription and carcinogenic risk. There is no epidemiological study reporting on the association between SSRI use and the incidence of bladder cancer. The aim of this study is to determine whether SSRI use influences the risk of bladder cancer.
METHODS
We conducted a nationwide retrospective cohort study by Taiwan's National Health Insurance Research Database from January 1, 1997 to December 31, 2013. 192,392 SSRI prescribed individuals were randomly matched 1 to 1 with 191,786 individuals who had never received any SSRIs by propensity scores match. The Cox Proportional Hazard models were conducted to examine the risk of bladder cancer between individuals prescribed SSRIs and individuals not prescribed SSRIs.
RESULTS
SSRIs were associated with significant reduced risk of bladder cancer with 0.5, 1, and 2 year induction periods (adjusted hazard ratio (aHR) = 0.86, 95% CI (confidence interval) = 0.76-0.98, aHR = 0.85, 95% CI = 0.75-0.97, and aHR = 0.77, 95% CI = 0.66-0.89). When examining the effect of specific SSRI, there was significantly lower risk of bladder cancer in individuals prescribed fluoxetine (6 month induction period: aHR = 0.78, 95% CI = 0.65-0.93; 1 year induction period: aHR = 0.78, 95% CI = 0.65-0.94; 2 year induction period: aHR = 0.73, 95% CI = 0.60-0.89), paroxetine (6 month induction period: aHR = 0.78, 95% CI = 0.61-0.99; 1 year induction period: aHR = 0.79, 95% CI = 0.61-1.01; 2 year induction period: aHR = 0.72, 95% CI = 0.54-0.95), and citalopram (6 month induction period: aHR = 0.74, 95% CI = 0.53-1.03; 1 year induction period: aHR = 0.70, 95% CI = 0.50-0.99; 2 year induction period: aHR = 0.60, 95% CI = 0.41-0.88).
CONCLUSIONS
Individuals prescribed fluoxetine, paroxetine, or citalopram had a reduced risk of bladder cancer in this large, cross-national database.
背景
既往研究表明选择性5-羟色胺再摄取抑制剂（SSRI）处方与致癌风险之间存在复杂的关联。尚无关于SSRI使用与膀胱癌发病率之间关联的流行病学研究报告。本研究的目的是确定SSRI的使用是否会影响膀胱癌风险。
方法
我们利用台湾国民健康保险研究数据库进行了一项全国性回顾性队列研究，研究时间从1997年1月1日至2013年12月31日。通过倾向得分匹配，将192,392名开具了SSRI处方的个体与191,786名从未接受过任何SSRI治疗的个体进行1:1随机匹配。采用Cox比例风险模型来检验开具SSRI处方的个体与未开具SSRI处方的个体之间患膀胱癌的风险。
结果
SSRI与膀胱癌风险显著降低相关，诱导期分别为0.5年、1年和2年（调整后风险比（aHR）=0.86，95%置信区间（CI）=0.76 - 0.98；aHR = 0.85，95% CI = 0.75 - 0.97；aHR = 0.77，95% CI = 0.66 - 0.89）。在检验特定SSRI的效果时，开具氟西汀处方的个体患膀胱癌风险显著降低（6个月诱导期：aHR = 0.78，95% CI = 0.65 - 0.93；1年诱导期：aHR = 0.78，95% CI = 0.65 - 0.94；2年诱导期：aHR = 0.73，95% CI = 0.60 - 0.89），帕罗西汀（6个月诱导期：aHR = 0.78，95% CI = 0.61 - 0.99；1年诱导期：aHR = 0.79，95% CI = 0.61 - 1.01；2年诱导期：aHR = 0.72，95% CI = 0.54 - 0.95），以及西酞普兰（6个月诱导期：aHR = 0.74，95% CI = 0.53 - 1.03；1年诱导期：aHR = 0.70，95% CI = 0.50 - 0.99；2年诱导期：aHR = 0.60，95% CI = 0.41 - 0.88）。
结论
在这个大型跨国数据库中，开具氟西汀、帕罗西汀或西酞普兰处方的个体患膀胱癌的风险降低。
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