Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea.
J Allergy Clin Immunol. 2021 Jan;147(1):135-143. doi: 10.1016/j.jaci.2020.04.041. Epub 2020 May 15.
Evidence regarding the risk of cancer development after asthma diagnosis is controversial and inconclusive.
This study sought to determine whether asthma is associated with an increased risk for incident cancer.
Two independent, population-based, longitudinal cohorts were examined, and estimated hazard ratios were determined using Cox regression. One group consisted of an unmatched cohort of 475,197 participants and a propensity score-matched cohort of 75,307 participants from the National Health Insurance Service-National Sample Cohort (NHIS-NSC; claims-based data from 2003 to 2015). The other group consisted of 5,440 participants from the Ansan-Ansung cohort (interview-based data from 2001 to 2014).
The NHIS-NSC matched cohort had 572,740 person-years of follow-up, 6,885 people with new asthma diagnoses, and 68,422 people without asthma diagnoses. Adults with asthma had a 75% greater risk of incident cancer overall. The excess risk for incident cancer was greatest during the first 2 years after asthma diagnosis, and this risk remained elevated throughout follow-up. Patients with nonatopic asthma had a greater risk of overall cancer than those with atopic asthma. A high cumulative dose of inhaled corticosteroids among asthma patients was associated with a 56% reduced risk of lung cancer, but had no effect on the risk of overall cancer. The results from the NHIS-NSC unmatched cohort and the Ansan-Ansung cohort were similar to the primary results from the NHIS-NSC matched cohort.
Asthma development was associated with an increased risk of subsequent cancer in 2 different Korean cohorts. Our findings provide an improved understanding of the pathogenesis of asthma and its relationship with carcinogenesis and suggest that clinicians should be aware of the higher risk of incident cancer among patients with asthma.
哮喘诊断后癌症发展风险的证据存在争议且尚无定论。
本研究旨在确定哮喘是否与癌症发病风险增加相关。
研究纳入了两个独立的基于人群的纵向队列，并使用 Cox 回归确定了估计的风险比。一组由未匹配的 475197 名参与者组成的队列和一组来自国家健康保险服务-国家样本队列（NHIS-NSC；2003 年至 2015 年的理赔数据）的 75307 名倾向评分匹配队列组成。另一组由 Ansan-Ansung 队列的 5440 名参与者组成（2001 年至 2014 年的访谈数据）。
NHIS-NSC 匹配队列的随访时间为 572740 人年，新诊断出哮喘的患者有 6885 人，没有哮喘的患者有 68422 人。成人哮喘患者整体癌症发病风险增加了 75%。哮喘诊断后前 2 年的癌症发病风险最高，且在整个随访期间风险持续升高。非特应性哮喘患者的总体癌症风险高于特应性哮喘患者。哮喘患者吸入皮质激素的累积剂量较高与肺癌风险降低 56%相关，但对总体癌症风险无影响。NHIS-NSC 未匹配队列和 Ansan-Ansung 队列的结果与 NHIS-NSC 匹配队列的主要结果相似。
在两个不同的韩国队列中，哮喘的发生与随后癌症的发生风险增加相关。我们的研究结果提供了对哮喘发病机制及其与致癌作用之间关系的更深入理解，并提示临床医生应意识到哮喘患者癌症发病风险增加。
