他汀类药物的使用与慢性阻塞性肺疾病患者肺癌风险：基于人群的队列研究。
Statin use and lung cancer risk in chronic obstructive pulmonary disease patients: a population-based cohort study.
机构信息
Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, V6T1Z3, Canada.
BC Cancer, Vancouver, Canada.
出版信息
Respir Res. 2020 May 19;21(1):118. doi: 10.1186/s12931-020-01344-w.
BACKGROUND
Patients living with chronic obstructive pulmonary disease (COPD) are at an increased risk of lung cancer. A common comorbidity of COPD is cardiovascular disease; as such, COPD patients often receive statins. This study sought to understand the association between statin exposure and lung cancer risk in a population-based cohort of COPD patients.
METHODS
We identified a population-based cohort of COPD patients based on having filled at least three prescriptions for an anticholinergic or short-acting beta-agonist (SABA). We used an array of methods of defining medication exposure including three conventional methods (ever statin exposure, cumulative duration of use, and cumulative dose) and two novel methods (recency-weighted cumulative duration of use and recency-weighted cumulative dose). To assess residual confounding, a negative control exposure was used to test the validity of our results. All exposure variables were time-dependent.
RESULTS
The population-based cohort of COPD had 39,879 patients with mean age of 70.6 (SD: 11.2) years and, of which, 53.5% were female. There were 12,469 patients who received at least one statin prescription. Results from the reference case multivariable analysis indicated a reduced risk from statin exposure (HR: 0.85 (95% CI: 0.73-1.00) in COPD patients, but this result not statistically significant. Using the two recency-weighted modelling approaches, statin exposure was associated with a statistically significant reduction in lung cancer risk (recency-weighted cumulative dose, HR: 0.85 (95% CI: 0.77-0.93) and recency-weighted cumulative duration of use, HR: 0.97 (95% CI: 0.96-0.99). Multivariable analysis incorporating the negative control exposure was not statistically significant (HR: 0.89 (95% CI: 0.75-1.10).
CONCLUSIONS
The results of this population-based analysis indicate that statin use in COPD patients may reduce the risk of lung cancer. While the effect was not statistically significantly across all exposure definitions, the overall results support the hypothesis that COPD patients might benefit from statin therapy.
背景
患有慢性阻塞性肺疾病（COPD）的患者患肺癌的风险增加。COPD 的常见合并症是心血管疾病；因此，COPD 患者经常服用他汀类药物。这项研究旨在了解基于人群的 COPD 患者队列中他汀类药物暴露与肺癌风险之间的关联。
方法
我们根据至少开具三种抗胆碱能药物或短效β-激动剂（SABA）处方，确定了一个基于人群的 COPD 患者队列。我们使用了一系列药物暴露定义方法，包括三种传统方法（曾用他汀类药物暴露、累积使用时间和累积剂量）和两种新方法（最近加权累积使用时间和最近加权累积剂量）。为了评估残余混杂，我们使用了阴性对照暴露来测试我们结果的有效性。所有暴露变量均为时间依赖性的。
结果
基于人群的 COPD 患者队列共有 39879 名患者，平均年龄为 70.6（标准差：11.2）岁，其中 53.5%为女性。有 12469 名患者至少接受了一种他汀类药物处方。参考病例多变量分析结果表明，他汀类药物暴露可降低风险（HR：0.85（95%CI：0.73-1.00）），但无统计学意义。使用两种最近加权建模方法，他汀类药物暴露与肺癌风险降低具有统计学意义（最近加权累积剂量，HR：0.85（95%CI：0.77-0.93）和最近加权累积使用时间，HR：0.97（95%CI：0.96-0.99））。纳入阴性对照暴露的多变量分析无统计学意义（HR：0.89（95%CI：0.75-1.10））。
结论
这项基于人群的分析结果表明，COPD 患者使用他汀类药物可能降低肺癌风险。虽然在所有暴露定义中，结果均无统计学意义，但总体结果支持了这样的假设，即 COPD 患者可能从他汀类药物治疗中受益。
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