放疗治疗鼻咽癌患者痴呆风险增加：一项全国基于人群的队列研究。
Increased risk of dementia in patients with nasopharyngeal cancer treated with radiation therapy: A nationwide population-based cohort study.
机构信息
School of Medicine, College of Medicine, Fu Jen Catholic University, Xinzhuang District, New Taipei City, 24205, Taiwan (R.O.C.); Department of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital, Fu Jen Catholic University, Taishan District, New Taipei City, 24352, Taiwan (R.O.C.).
School of Public Health, National Defense Medical Center, Neihu District, Taipei City, 11490, Taiwan (R.O.C.).
出版信息
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104303. doi: 10.1016/j.archger.2020.104303. Epub 2020 Nov 22.
PURPOSE
We evaluated the risk of dementia in patients with nasopharyngeal cancer (NPC) after undergoing radiation therapy (RT).
METHODS
Between January 1, 2000, and December 31, 2015, 594 patients newly diagnosed with NPC and treated with RT (NPC cohort) were identified from the Longitudinal Health Insurance Database (LHID) for this nationwide population-based matched cohort study. LHID is a subset of the National Health Insurance Research Database of Taiwan. We selected 2376 controls (non-NPC comparison cohort) using a four-fold propensity score-matched by sex, age, comorbidities, education level, tobacco abuse, and index date (the date when the patient received first RT). After adjusting for confounding factors, Fine and Gray's competing risk analysis compared dementia development between the NPC study cohort and non-NPC comparison cohort over the observation period from 2000 to 2015.
RESULTS
Dementia development was 6.57% (39 of 594) and 4.42% (105 of 2376) in the NPC study cohort and non-NPC comparison cohort, respectively. Patients with NPC receiving RT were more likely to develop dementia than the comparison cohort, with a crude hazard ratio (HR) of 1.63 [95% confidence interval (CI) = 1.25-2.13, P < 0.001]. After adjusting for age, sex, education level, tobacco abuse, comorbidity, geographic area, urbanization level of the residence, and care level, the adjusted HR was 1.91 (95% CI = 1.42-2.51, P < 0.001).
CONCLUSIONS
Patients with NPC receiving RT had a 1.91-fold higher risk of dementia than the non-NPC comparison controls.
目的
我们评估了接受放射治疗（RT）的鼻咽癌（NPC）患者发生痴呆的风险。
方法
在这项全国性基于人群的匹配队列研究中，我们从台湾全民健康保险研究数据库的纵向健康保险数据库（LHID）中确定了 594 名于 2000 年 1 月 1 日至 2015 年 12 月 31 日期间新诊断为 NPC 并接受 RT 治疗的患者（NPC 队列）。LHID 是台湾全民健康保险研究数据库的一个子集。我们通过性别、年龄、合并症、教育程度、烟草滥用和指数日期（患者接受首次 RT 的日期）对 2376 名对照者（非 NPC 比较队列）进行了四倍倾向评分匹配。在调整混杂因素后，Fine 和 Gray 的竞争风险分析比较了 NPC 研究队列和非 NPC 比较队列在 2000 年至 2015 年的观察期间痴呆的发展情况。
结果
NPC 研究队列和非 NPC 比较队列中痴呆的发展率分别为 6.57%（39/594）和 4.42%（105/2376）。接受 RT 的 NPC 患者发生痴呆的可能性高于对照组，粗危险比（HR）为 1.63 [95%置信区间（CI）=1.25-2.13，P<0.001]。在调整年龄、性别、教育程度、烟草滥用、合并症、地理区域、居住地的城市化水平和护理水平后，调整后的 HR 为 1.91（95% CI=1.42-2.51，P<0.001）。
结论
接受 RT 的 NPC 患者发生痴呆的风险比非 NPC 对照组高 1.91 倍。
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