Department of Health Convergence, Ewha Womans University, Seoul, South Korea.
Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.
BMC Pulm Med. 2020 Jun 15;20(1):170. doi: 10.1186/s12890-020-01194-8.
COPD is a well-known risk factor for lung cancer, independent of smoking behavior. By investigating the retrospective National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea, this study attempted to prove the hypothesis that COPD is a risk factor for major cancers developing outside of the lungs. We also aimed to investigate the environmental factors associated with the development of lung cancer in COPD patients.
This study analyzed data from the NHIS-NSC over a 12-year period. Among the 514,795 subjects in the NHIS-NSC, 16,757 patients who were diagnosed with any cancer from 2002 to 2003 were excluded. This cohort enrolled six arms consisting of never-smokers without COPD (N = 313,553), former smokers without COPD (N = 41,359), smokers without COPD (N = 112,627), never-smokers with COPD (N = 7789), former smokers with COPD (N = 1085), and smokers with COPD (N = 2677).
Incident rate of lung cancer per 100,000 person-year was higher according to smoking and COPD (216 in non-COPD and 757 in COPD among never-smokers, 271 in non-COPD and 1266 in COPD among former smokers, 394 in non-COPD and 1560 in COPD among smokers, p < 0.01). Old age, male sex, lower BMI, low exercise level, history of diabetes mellitus, smoking, and COPD were independent factors associated with the development of lung cancer (p < 0.01). Multi-variable analyses showed that COPD, regardless of smoking status, contributed to the development of lung cancer, and colorectal cancer and liver cancer among other major cancers (p < 0.01).
Our data suggested that COPD was an independent risk factor for the development of lung cancer, and colorectal cancer and liver cancer among other major cancers in the Korean population, regardless of smoking status.
COPD 是肺癌的已知危险因素，与吸烟行为无关。本研究通过调查韩国的国家健康保险服务-全国抽样队列（NHIS-NSC）的回顾性数据，旨在证明 COPD 是肺部以外主要癌症发生的危险因素这一假说。我们还旨在调查与 COPD 患者肺癌发生相关的环境因素。
本研究分析了 NHIS-NSC 12 年的数据。在 NHIS-NSC 的 514795 名受试者中，排除了 2002 年至 2003 年期间被诊断患有任何癌症的 16757 名患者。该队列纳入了由六组组成的人群：从不吸烟且无 COPD（N=313553）、曾吸烟且无 COPD（N=41359）、不吸烟且有 COPD（N=7789）、从不吸烟且有 COPD（N=112627）、曾吸烟且有 COPD（N=1085）和吸烟且有 COPD（N=2677）。
在不吸烟者中，每 100000 人年的肺癌发病率根据吸烟和 COPD 情况有所不同（非 COPD 组为 216，COPD 组为 757；非 COPD 组为 271，COPD 组为 1266；非 COPD 组为 394，COPD 组为 1560；p<0.01）。年龄较大、男性、较低的 BMI、较低的运动水平、糖尿病史、吸烟和 COPD 是肺癌发生的独立相关因素（p<0.01）。多变量分析显示，COPD 无论吸烟状况如何，都是肺癌以及结直肠癌和肝癌等其他主要癌症发生的独立危险因素（p<0.01）。
我们的数据表明，COPD 是韩国人群肺癌以及结直肠癌和肝癌等其他主要癌症发生的独立危险因素，与吸烟状况无关。
