Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey.
Endocrine. 2022 Aug;77(2):363-371. doi: 10.1007/s12020-022-03082-z. Epub 2022 May 24.
To investigate the prevalence of cancer in patients with acromegaly and the variables associated with malignant and premalignant lesions detected by cancer screening.
The data of 214 patients diagnosed with acromegaly in our institution were evaluated retrospectively. Prevalence of cancer was compared with national rates to estimate standardized incidence ratios (SIRs). The relationships of malignant and premalignant lesions detected by cancer screening with demographic, clinical, and radiological variables were also analyzed.
Cancer was detected in 24 (13.4%) of 179 patients enrolled in the study. Compared to the general population, the incidence of all malignancies was increased in both women and men with acromegaly (SIR: 4.78, 95% CI: 2.43-8.53, p = 0.002 and SIR: 8.97, 95% CI: 5.51-14.7, p < 0.001, respectively). The most common cancers were thyroid, colorectal, breast, kidney, gastric, and testicular cancer, respectively. Duration of disease was the only independent risk factor for the development of cancer (OR: 1.007, 95% CI: 1.002-1.011, p = 0.002). Malignant/premalignant lesions were detected in 21.5% of the patients with a colonoscopy scanning procedure and in 20.8% with an esophagogastroduodenoscopy procedure, and current age was found to be higher among the patients with malignant/premalignant lesions (p = 0.023 and p = 0.003, respectively). Breast cancer was detected in 3.7% of screening tests performed with mammography.
In this study, it was shown that the prevalence of cancer increases with acromegaly and this increase is associated with disease duration. Considering the increase in the number of premalignant lesions, the scope of cancer screening recommendations in the guidelines should be expanded to ensure early diagnosis.
研究肢端肥大症患者中癌症的患病率，以及与癌症筛查发现的恶性和癌前病变相关的变量。
回顾性评估了我院 214 例确诊肢端肥大症患者的数据。将癌症的患病率与全国发病率进行比较，以估计标准化发病比（SIR）。还分析了癌症筛查发现的恶性和癌前病变与人口统计学、临床和影像学变量的关系。
在纳入研究的 179 例患者中，有 24 例（13.4%）发现癌症。与普通人群相比，肢端肥大症患者的所有恶性肿瘤发病率均升高，女性 SIR 为 4.78（95%CI：2.43-8.53，p=0.002），男性 SIR 为 8.97（95%CI：5.51-14.7，p<0.001）。最常见的癌症分别为甲状腺癌、结直肠癌、乳腺癌、肾癌、胃癌和睾丸癌。疾病持续时间是癌症发生的唯一独立危险因素（OR：1.007，95%CI：1.002-1.011，p=0.002）。结肠镜检查发现恶性/癌前病变的患者占 21.5%，上消化道内镜检查发现恶性/癌前病变的患者占 20.8%，且这些患者的年龄均高于无恶性/癌前病变的患者（p=0.023 和 p=0.003）。乳房 X 线摄影术筛查发现 3.7%的患者患有乳腺癌。
本研究表明，肢端肥大症患者的癌症患病率增加，且这种增加与疾病持续时间相关。考虑到癌前病变数量的增加，指南中癌症筛查建议的范围应扩大，以确保早期诊断。
