Department of Anesthesiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
Cancer. 2021 May 15;127(10):1648-1657. doi: 10.1002/cncr.33285. Epub 2020 Dec 28.
Cancer is the second leading cause of death globally, and researchers seek to identify modifiable risk factors Over the past several decades, there has been ongoing debate whether opioids are associated with cancer development, metastasis, or recurrence. Basic science, clinical, and observational studies have produced conflicting results. The authors examined the association between prescription opioids and incident cancers using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. A complex relation was observed between prescription opioids and incident cancer, and cancer site may be an important determinant.
By using linked SEER cancer registry and Medicare claims from 2008 through 2013, a case-control study was conducted examining the relation between cancer onset and prior opioid exposure. Logistic regression was used to account for differences between cases and controls for 10 cancer sites.
Of the population studied (n = 348,319), 34% were prescribed opioids, 79.5% were white, 36.9% were dually eligible (for both Medicare and Medicaid), 13% lived in a rural area, 52.7% had ≥1 comorbidity, and 16% had a smoking-related diagnosis. Patients exposed to opioids had a lower odds ratio (OR) associated with breast cancer (adjusted OR, 0.96; 95% CI, 0.92-0.99) and colon cancer (adjusted OR, 0.90; 95% CI, 0.86-0.93) compared with controls. Higher ORs for kidney cancer, leukemia, liver cancer, lung cancer, and lymphoma, ranging from lung cancer (OR, 1.04; 95% CI, 1.01-1.07) to liver cancer (OR, 1.19; 95% CI, 1.08-1.31), were present in the exposed population.
The current results suggest that an association exists between prescription opioids and incident cancer and that cancer site may play an important role. These findings can direct future research on specific patient populations that may benefit or be harmed by prescription opioid exposure.
癌症是全球第二大死亡原因，研究人员正在努力寻找可改变的风险因素。在过去几十年中，一直存在关于阿片类药物是否与癌症的发生、转移或复发有关的争论。基础科学、临床和观察性研究得出的结果相互矛盾。作者使用监测、流行病学和最终结果（SEER）-医疗保险数据库研究了处方类阿片类药物与新发癌症之间的关联。研究观察到处方类阿片类药物与新发癌症之间存在复杂关系，且癌症部位可能是一个重要的决定因素。
通过使用 2008 年至 2013 年期间的 SEER 癌症登记处和医疗保险索赔记录进行病例对照研究，研究了癌症发病与先前阿片类药物暴露之间的关系。使用逻辑回归来解释病例和对照组之间在 10 个癌症部位的差异。
在所研究的人群（n=348319）中，34%的人被开了阿片类药物处方，79.5%是白人，36.9%同时符合医疗保险和医疗补助资格（即双重资格），13%居住在农村地区，52.7%有≥1种合并症，16%有与吸烟相关的诊断。与对照组相比，暴露于阿片类药物的患者的乳腺癌（调整后的比值比，0.96；95%置信区间，0.92-0.99）和结肠癌（调整后的比值比，0.90；95%置信区间，0.86-0.93）的比值比更低。暴露组中，肾癌、白血病、肝癌、肺癌和淋巴瘤的比值比更高，范围从肺癌（比值比，1.04；95%置信区间，1.01-1.07）到肝癌（比值比，1.19；95%置信区间，1.08-1.31）。
目前的结果表明，处方类阿片类药物与新发癌症之间存在关联，且癌症部位可能起着重要作用。这些发现可以指导针对特定患者群体的未来研究，这些患者群体可能因处方类阿片类药物暴露而受益或受害。
