Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
Int J Cancer. 2021 May 1;148(9):2148-2157. doi: 10.1002/ijc.33379. Epub 2020 Nov 30.
Prior studies showed that calcium channel blockers (CCBs) could modify cancer risk, but data on gastric cancer (GC) are limited. We aimed to investigate whether CCBs could modify GC risk in Helicobacter pylori-eradicated patients. H pylori-infected patients with hypertension who are aged ≥50 and had received clarithromycin-based triple therapy between 2003 and 2016 were identified from a territory-wide healthcare database. Patients with eradication failure, GC diagnosed within 6 months after HP eradication, and gastric ulcer were excluded. Time-fixed Cox model with one-to-one propensity score matching was used to calculate hazard ratio (HR) of GC with CCBs. Sensitivity analysis using time-dependent multivariable Cox model in which CCB use was treated as time-varying covariate was also performed to address immortal time bias. 17 622 (29.6%) H pylori-eradicated patients with hypertension were included. During a median follow-up of 8.6 years, 105 (0.6%) developed GC. After PS matching, CCBs were associated with a lower GC risk (HR: 0.56; 95% CI: 0.32-0.97). Time-dependent analysis showed consistent result (aHR: 0.50; 95% CI: 0.33-0.75). A longer duration of CCB use was associated with even lower GC risk (adjusted HR [aHR]: 0.69; 95% CI: 0.61-0.79 for every 1-year increase in use). Long-acting CCBs (aHR: 0.47; 95% CI: 0.29-0.76) and dihydropyridines (aHR: 0.49; 95% CI: 0.32-0.73) conferred greater benefit than short-acting ones (aHR: 0.60; 95% CI: 0.36-1.03) and nondihydropyridines (aHR: 0.76; 95% CI: 0.24-2.48). The aHR was 0.57 (95% CI: 0.34-0.97) for noncardia and 0.59 (95% CI: 0.27-1.31) for cardia cancer. Use of CCBs was associated with lower risk of GC development in H pylori-eradicated patients, in a duration- and dose-response manner.
先前的研究表明，钙通道阻滞剂（CCBs）可能会改变癌症风险，但有关胃癌（GC）的数据有限。我们旨在研究 CCB 是否可以改变 H. pylori 根除患者的 GC 风险。从全港医疗数据库中确定了患有高血压且年龄≥50 岁并在 2003 年至 2016 年间接受克拉霉素三联疗法的 H. pylori 感染患者。排除了根除失败、HP 根除后 6 个月内诊断为 GC 和胃溃疡的患者。使用时间固定的 Cox 模型和一对一倾向评分匹配来计算 CCB 治疗的 GC 风险比（HR）。还使用时间依赖性多变量 Cox 模型进行敏感性分析，其中 CCB 使用被视为时间变化的协变量，以解决不朽时间偏倚。纳入了 17622 名（29.6%）患有高血压且 H. pylori 已根除的患者。在中位随访 8.6 年后，有 105 名（0.6%）患者发生 GC。在 PS 匹配后，CCB 与较低的 GC 风险相关（HR：0.56；95%CI：0.32-0.97）。时间依赖性分析显示出一致的结果（aHR：0.50；95%CI：0.33-0.75）。较长时间的 CCB 使用与更低的 GC 风险相关（调整后的 HR[aHR]：每增加 1 年使用，风险降低 0.69；95%CI：0.61-0.79）。长效 CCB（aHR：0.47；95%CI：0.29-0.76）和二氢吡啶（aHR：0.49；95%CI：0.32-0.73）比短效 CCB（aHR：0.60；95%CI：0.36-1.03）和非二氢吡啶（aHR：0.76；95%CI：0.24-2.48）更有益。非贲门癌的 aHR 为 0.57（95%CI：0.34-0.97），贲门癌为 0.59（95%CI：0.27-1.31）。在 H. pylori 根除患者中，CCB 的使用与 GC 发展风险降低相关，呈剂量-反应关系。
