Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Department of Public Health, Yonsei University, Seoul, Korea.
Epidemiol Health. 2021;43:e2021093. doi: 10.4178/epih.e2021093. Epub 2021 Nov 2.
We investigated the risk of chemotherapy-related and radiotherapy-related cognitive impairment in colorectal cancer patients.
Medical use data of colorectal cancer patients were obtained from the Korean National Health Insurance Database from 2004 to 2018. We randomly selected 40% of all colorectal cancer patients (n=148,848). Cognitive impairment was defined as having 1 or more International Classification of Diseases, 10th revision diagnostic codes for dementia or mild cognitive impairment. Patients aged 18 years or younger, patients diagnosed with cognitive impairment before colorectal cancer diagnosis (n=8,225), and patients who did not receive primary resection (n=45,320) were excluded. The effects of individual chemotherapy regimens on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate the overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Landmark analyses with different lag times were conducted as sensitivity analyses.
Chemotherapy did not increase the risk of cognitive impairment in colorectal cancer patients (colon cancer: HR, 0.92; 95% confidence interval [CI], 0.83 to 1.03; rectal cancer: HR, 0.88; 95% CI, 0.75 to 1.04), while radiotherapy was negatively associated with cognitive impairment in rectal cancer patients (HR, 0.01; 95% CI, 0.84 to 0.99). Varying directions of the associations between regimens and cognitive impairment were detected. The adverse effect of certain chemotherapy regimens on cognition was more prominent in older adults.
Chemotherapy and radiotherapy did not increase the risk of cognitive impairment. Older patients with low cognitive reserve could be affected by the adverse cognitive effects of chemotherapy.
我们研究了结直肠癌患者接受化疗和放疗相关认知障碍的风险。
我们从 2004 年至 2018 年的韩国国家健康保险数据库中获取了结直肠癌患者的医疗使用数据。我们随机选择了 40%的所有结直肠癌患者（n=148848）。认知障碍的定义为有 1 个或多个国际疾病分类，第 10 版诊断代码为痴呆或轻度认知障碍。年龄在 18 岁以下的患者、在结直肠癌诊断前就被诊断为认知障碍的患者（n=8225）以及未接受原发性切除术的患者（n=45320）被排除在外。我们估计了个体化疗方案对认知障碍的影响。我们还估计了放疗对直肠癌患者的影响。采用时间依赖性竞争风险 Cox 回归分别估计结肠癌和直肠癌的总风险比（HR）和年龄特异性 HR。进行了不同滞后时间的 landmark 分析作为敏感性分析。
化疗并未增加结直肠癌患者认知障碍的风险（结肠癌：HR，0.92；95%置信区间[CI]，0.83 至 1.03；直肠癌：HR，0.88；95%CI，0.75 至 1.04），而放疗与直肠癌患者认知障碍呈负相关（HR，0.01；95%CI，0.84 至 0.99）。不同方案与认知障碍之间的关联方向不同。某些化疗方案对认知的不良影响在老年人中更为明显。
化疗和放疗并未增加认知障碍的风险。认知储备较低的老年患者可能会受到化疗的不良认知影响。
