Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,
Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Digestion. 2022;103(3):192-204. doi: 10.1159/000520924. Epub 2021 Dec 20.
Oesophageal cancer comprises 2 different histological variants: oesophageal squamous-cell carcinoma (ESCC) and adenocarcinoma (EAC). While there are multiple therapeutic options for both types, patients with advanced or metastatic oesophageal cancer still suffer from poor prognosis.
The study aimed to examine the association between the risk of oesophageal cancer and medications and to estimate the chemopreventive effects of commonly used drugs.
A multicentre retrospective cohort study was conducted using data from 9 hospital databases of hospitalized patients between 2014 and 2019. The primary outcomes were ESCC and EAC. The association of oesophageal cancer with drug use and clinical factors was evaluated. Odds ratios (ORs) were adjusted for age, sex, Charlson comorbidity index scores, and smoking with/without gastro-oesophageal reflux disease.
The use of proton pump inhibitors (PPIs) (adjusted OR [aOR] 0.48, p < 0.0001), aspirin (aOR 0.32, p < 0.0001), cyclooxygenase-2 inhibitor (COX2I) (aOR 0.70, p = 0.0005), steroid (aOR 0.19, p < 0.0001), statin (aOR 0.43, p < 0.0001), and metformin (aOR 0.42, p < 0.0001) was associated with a lower risk of ESCC than that in non-use. The use of aspirin (aOR 0.33, p = 0.0006) and steroids (aOR 0.54, p = 0.022) was associated with a lower risk of EAC than that in non-use.
COX2Is, statins, metformin, and PPIs could help in prevention of ESCC, and aspirin and steroids may be chemopreventive for both types of oesophageal cancer.
食管癌包括两种不同的组织学类型：食管鳞状细胞癌（ESCC）和腺癌（EAC）。虽然这两种类型都有多种治疗选择，但患有晚期或转移性食管癌的患者预后仍然较差。
本研究旨在探讨药物与食管癌风险之间的关联，并评估常用药物的化学预防作用。
采用 2014 年至 2019 年 9 家医院住院患者数据库进行多中心回顾性队列研究。主要结局为 ESCC 和 EAC。评估药物使用与临床因素与食管癌的关系。使用年龄、性别、Charlson 合并症指数评分和吸烟伴/不伴胃食管反流病对比值比（OR）进行调整。
质子泵抑制剂（PPIs）（调整后的 OR [aOR] 0.48，p < 0.0001）、阿司匹林（aOR 0.32，p < 0.0001）、环氧化酶-2 抑制剂（COX2I）（aOR 0.70，p = 0.0005）、类固醇（aOR 0.19，p < 0.0001）、他汀类药物（aOR 0.43，p < 0.0001）和二甲双胍（aOR 0.42，p < 0.0001）的使用与 ESCC 风险降低相关。与非使用者相比，阿司匹林（aOR 0.33，p = 0.0006）和类固醇（aOR 0.54，p = 0.022）的使用与 EAC 风险降低相关。
COX2I、他汀类药物、二甲双胍和 PPIs 可能有助于预防 ESCC，而阿司匹林和类固醇可能对两种类型的食管癌具有化学预防作用。
