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特发性肺纤维化患者的癌症发病风险:一项全国性队列研究。

Risk of cancer incidence in patients with idiopathic pulmonary fibrosis: A nationwide cohort study.

机构信息

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Respirology. 2021 Feb;26(2):180-187. doi: 10.1111/resp.13911. Epub 2020 Jul 22.

Abstract

BACKGROUND AND OBJECTIVE

IPF shares common risk factors and has pathogenic similarities with cancer. However, limited population-based data are available on cancer risk among patients with IPF. Herein, we investigated whether IPF is associated with an increased risk for cancer incidence from a nationwide database in South Korea.

METHODS

In this population-based cohort study, patients with IPF were enrolled from 2009 to 2014, and matched controls were randomly selected at a control-to-case ratio of 3:1. In both groups, individuals diagnosed with any malignancy before the index date were excluded. The incidence rates of cancer were measured as the number of events per 1000 person-years. Multivariable Cox regression models were used to assess the cancer incidence risk.

RESULTS

This study included 25 241 patients with IPF and 75 723 matched controls. The overall cancer incidence in patients with IPF was 29.0 cases per 1000 person-years, and it was significantly higher in the IPF group than in the non-IPF group (HR, 2.09; 95% CI, 1.96-2.16). Lung cancer showed the highest HR (5.89; 95% CI, 5.40-6.42), followed by lymphoma, skin, uterine cervical, multiple myeloma, thyroid, leukaemia, pancreatic, liver and prostate cancer. Moreover, adjustment for the effects of smoking and other cancer-associated covariates had little effect on the HR of overall and specific cancers.

CONCLUSION

The cancer incidence risk was higher in the IPF group than in the non-IPF group. Therefore, healthcare providers should be aware of this risk when treating patients with IPF.

摘要

背景和目的

特发性肺纤维化(IPF)与癌症具有共同的危险因素和发病机制相似性。然而,目前关于 IPF 患者癌症风险的基于人群的数据有限。在此,我们利用韩国全国数据库研究了 IPF 是否与癌症发病率增加相关。

方法

在这项基于人群的队列研究中,2009 年至 2014 年期间纳入了 IPF 患者,以 3:1 的病例对照比随机选择匹配对照。在两组中,均排除在索引日期之前诊断为任何恶性肿瘤的个体。癌症的发病率以每 1000 人年的事件数来衡量。采用多变量 Cox 回归模型评估癌症发病风险。

结果

本研究纳入了 25241 例 IPF 患者和 75723 例匹配对照。IPF 患者的总体癌症发病率为 29.0 例/1000 人年,显著高于非 IPF 组(HR,2.09;95%CI,1.96-2.16)。肺癌的 HR 最高(5.89;95%CI,5.40-6.42),其次是淋巴瘤、皮肤、子宫颈、多发性骨髓瘤、甲状腺、白血病、胰腺癌、肝癌和前列腺癌。此外,调整吸烟和其他癌症相关协变量的影响对总体和特定癌症的 HR 影响不大。

结论

IPF 组的癌症发病率风险高于非 IPF 组。因此,在治疗 IPF 患者时,医疗保健提供者应意识到这一风险。

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