Ge Fan, Feng Yi, Huo Zhenyu, Li Caichen, Wang Runchen, Wen Yaokai, Gao Sirui, Peng Haoxin, Wu Xiangrong, Liang Hengrui, Cheng Bo, Zhong Ran, He Jianxing, Liang Wenhua
Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
First Clinical School, Guangzhou Medical University, Guangzhou, China.
Transl Lung Cancer Res. 2021 Mar;10(3):1266-1276. doi: 10.21037/tlcr-20-1126.
It remains uncertain whether there is a protective effect of inhaled corticosteroids (ICs) against lung cancer in chronic obstructive pulmonary disease (COPD) patients.
Databases including PubMed, Web of Science, EMBASE, and Medline were comprehensively searched. Random-effects model meta-analysis was conducted to calculate the hazard ratios (HRs) for lung cancer incidence among ICs users versus non-ICs users in patients with COPD. Stratified analysis was performed based on region and age of each study. This review was registered on PROSPERO (registration number CRD42020159082).
Based on data from 181,859 COPD patients with a total follow-up duration of 1,109,339.9 person-years, we identified that the use of ICs in COPD patients was associated with a decreased risk of lung cancer [HR: 0.73, 95% confidence interval (CI): 0.62-0.86; P<0.001]. The region-specific HRs for lung cancer incidence were 0.62 (95% CI: 0.62-0.86; P=0.004), 0.77 (95% CI: 0.60-0.97; P=0.028) and 0.81 (95% CI: 0.61-1.08; P=0.155) among European, Asian and North American COPD patients, respectively. Additionally, we found the consistent outcome among age groups (≥70 years old: HR: 0.73, 95% CI: 0.65-0.99, P=0.043; <70 years old: HR: 0.74, 95% CI: 0.56-0.99, P=0.040).
This study demonstrates that ICs have a protective effect against lung cancer in COPD patients. It could provide guidance for clinicians in the prevention of lung cancer among patients with COPD.
吸入性糖皮质激素（ICs）对慢性阻塞性肺疾病（COPD）患者的肺癌是否具有保护作用仍不确定。
全面检索包括PubMed、Web of Science、EMBASE和Medline在内的数据库。采用随机效应模型进行荟萃分析，以计算COPD患者中使用ICs者与未使用ICs者肺癌发病率的风险比（HRs）。根据每项研究的地区和年龄进行分层分析。本综述已在PROSPERO上注册（注册号CRD42020159082）。
基于181,859例COPD患者的数据，总随访时间为1,109,339.9人年，我们发现COPD患者使用ICs与肺癌风险降低相关[HR：0.73，95%置信区间（CI）：0.62 - 0.86；P<0.001]。欧洲、亚洲和北美COPD患者肺癌发病率的地区特异性HRs分别为0.62（95%CI：0.62 - 0.86；P = 0.004）、0.77（95%CI：0.60 - 0.97；P = 0.028）和0.81（95%CI：0.61 - 1.08；P = 0.155）。此外，我们在各年龄组中发现了一致的结果（≥70岁：HR：0.73，95%CI：0.65 - 0.99，P = 0.043；<70岁：HR：0.74，95%CI：0.56 - 0.99，P = 0.040）。
本研究表明ICs对COPD患者的肺癌具有保护作用。它可为临床医生预防COPD患者肺癌提供指导。
