Dana-Farber Cancer Institute, Boston, MA, USA.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Br J Cancer. 2020 Sep;123(5):844-851. doi: 10.1038/s41416-020-0939-y. Epub 2020 Jun 16.
Despite several plausible biological mechanisms linking proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) with colorectal tumorigenesis, their association with risk of colorectal cancer (CRC) has not been adequately assessed in prospective epidemiological studies.
We evaluated the association of acid-suppressive medication use with CRC risk among 175,871 (PPI) and 208,831 (H2RA) participants from three large prospective cohort studies. Medication use was assessed at baseline and updated biennially. The association was evaluated using multivariate Cox proportional hazards regression models.
There was no significant association between baseline PPI use (hazard ratio (HR) = 0.89, 95% confidence interval (CI), 0.71-1.12) or PPI use after a lag of 8-10 years (HR = 1.12, 95% CI, 0.78-1.59) with CRC risk. We observed no significant association between H2RA use after a lag of 8-10 years and CRC risk (HR = 1.02, 95% CI, 0.81-1.28), while risk was lower for participants with baseline H2RA use (HR = 0.76, 95% CI, 0.60-0.95). Duration of PPI use or H2RA use was not associated with CRC risk (P-trend = 0.21 and 0.95, respectively).
Among participants from three large prospective cohorts, use of PPI or H2RA was not associated with higher risk of colorectal cancer.
尽管质子泵抑制剂 (PPI) 和 H2 受体拮抗剂 (H2RA) 与结直肠肿瘤发生之间存在几种合理的生物学机制，但它们与结直肠癌 (CRC) 风险的关联在前瞻性流行病学研究中尚未得到充分评估。
我们评估了在来自三项大型前瞻性队列研究的 175871 名（PPI）和 208831 名（H2RA）参与者中，使用酸抑制药物与 CRC 风险之间的关联。在基线时评估药物使用情况，并每两年更新一次。使用多变量 Cox 比例风险回归模型评估关联。
基线时使用 PPI（风险比 (HR) = 0.89，95%置信区间 (CI)，0.71-1.12）或使用 PPI 后 8-10 年的 lag 期（HR = 1.12，95% CI，0.78-1.59）与 CRC 风险之间没有显著关联。我们观察到在使用 H2RA 后 8-10 年 lag 期与 CRC 风险之间没有显著关联（HR = 1.02，95% CI，0.81-1.28），而基线时使用 H2RA 的参与者风险较低（HR = 0.76，95% CI，0.60-0.95）。PPI 或 H2RA 的使用持续时间与 CRC 风险无关（P 趋势分别为 0.21 和 0.95）。
在来自三项大型前瞻性队列的参与者中，使用 PPI 或 H2RA 与结直肠癌风险增加无关。
