Bonnesen Barbara, Sivapalan Pradeesh, Jordan Alexander, Pedersen Johannes Wirenfeldt, Bergsøe Christina Marisa, Eklöf Josefin, Toennesen Louise Lindhardt, Jensen Sidse Graff, Naqibullah Matiullah, Saghir Zaigham, Jensen Jens-Ulrik Stæhr
Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark.
Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark.
Biomedicines. 2022 Jun 21;10(7):1463. doi: 10.3390/biomedicines10071463.
Chronic inflammation such as asthma may lead to higher risks of malignancy, which may be inhibited by anti-inflammatory medicine such as inhaled corticosteroids (ICS). The aim of this study was to evaluate if patients with asthma-Chronic Obstructive Pulmonary Disease (COPD) overlap have a higher risk of malignancy than patients with COPD without asthma, and, secondarily, if inhaled corticosteroids modify such a risk in a nationwide multi-center retrospective cohort study of Danish COPD-outpatients with or without asthma. Patients with asthma-COPD overlap were propensity score matched (PSM) 1:2 to patients with COPD without asthma. The endpoint was cancer diagnosis within 2 years. Patients were stratified depending on prior malignancy within 5 years. ICS was explored as a possible risk modifier. We included 50,897 outpatients with COPD; 88% without prior malignancy and 20% with asthma. In the PSM cohorts, 26,003 patients without prior malignancy and 3331 patients with prior malignancy were analyzed. There was no association between asthma-COPD overlap and cancer with hazard ratio (HR) = 0.92, CI = 0.78-1.08, = 0.31 (no prior malignancy) and HR = 1.04, CI = 0.85-1.26, and = 0.74 (prior malignancy) as compared to patients with COPD without asthma. ICS did not seem to modify the risk of cancer. In conclusion, in our study, asthma-COPD overlap was not associated with an increased risk of cancer events.
诸如哮喘之类的慢性炎症可能会导致更高的恶性肿瘤风险，而这种风险可能会被吸入性糖皮质激素（ICS）等抗炎药物所抑制。本研究的目的是评估哮喘-慢性阻塞性肺疾病（COPD）重叠患者是否比无哮喘的COPD患者具有更高的恶性肿瘤风险，其次，在一项针对丹麦有或无哮喘的COPD门诊患者的全国多中心回顾性队列研究中，吸入性糖皮质激素是否会改变这种风险。哮喘-COPD重叠患者与无哮喘的COPD患者按1:2的倾向评分进行匹配（PSM）。终点是2年内的癌症诊断。根据5年内是否有过恶性肿瘤对患者进行分层。将ICS作为一种可能的风险调节因素进行研究。我们纳入了50897例COPD门诊患者；88%无既往恶性肿瘤史，20%患有哮喘。在PSM队列中，分析了26003例无既往恶性肿瘤史的患者和3331例有既往恶性肿瘤史的患者。与无哮喘的COPD患者相比，哮喘-COPD重叠与癌症之间无关联，风险比（HR）=0.92，置信区间（CI）=0.78-1.08，P=0.31（无既往恶性肿瘤史），HR=1.04，CI=0.85-1.26，P=0.74（有既往恶性肿瘤史）。ICS似乎并未改变癌症风险。总之，在我们的研究中，哮喘-COPD重叠与癌症事件风险增加无关。
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