Patel Ankoor H, Li You, Minacapelli Carlos D, Catalano Kaitlyn, Rustgi Vinod
Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
Cureus. 2023 Feb 21;15(2):e35259. doi: 10.7759/cureus.35259. eCollection 2023 Feb.
Background Rifaximin and/or lactulose therapy is widely used in cirrhotic patients for the prevention and treatment of hepatic encephalopathy. The incidence of gastrointestinal cancers in these patients on lactulose, rifaximin, and/or combination therapy is unknown. We investigated the possible effect of lactulose and rifaximin on cancer risk in patients with cirrhosis using the MarketScan database. Methods A retrospective cohort study was conducted using the Truven Health MarketScan Commercial Claims databases from 2007-2017. An index date was defined for each participant as the earliest date of cirrhosis diagnosis. A baseline period for each participant was defined as the 12 months prior to the first medication date while the study follow-up period represented the period from the initiation of the medication to its cessation. ANOVA was used to compare all continuous measures of age and duration of medication. Wald Chi-square tests were performed to test the associations between the study groups. Results A total of 12,409 patients were included in our study. The rifaximin only cohort had the greatest reduction in risk of developing colon cancer, esophageal cancer, and stomach cancer compared to the other groups. Rifaximin reduced the risk of colon cancer and esophageal cancer by 59.42% and 70.37%, respectively, compared to patients taking lactulose only. Patients in the lactulose plus rifaximin cohort had the highest rate of development of pancreatic cancer (lactulose plus rifaximin vs rifaximin only vs lactulose only, 0.45% vs 0.24% vs 0.21%; P < 0.0001) and liver and intrahepatic bile duct cancers (11.73% vs 5.84% vs 5.49%; P < 0.0001). Conclusion Colon, esophageal, and gastric cancers had a marked incidence reduction in the rifaximin only cohort compared to the other cohorts studied.
利福昔明和/或乳果糖疗法广泛用于肝硬化患者，以预防和治疗肝性脑病。这些接受乳果糖、利福昔明和/或联合治疗的患者中胃肠道癌症的发病率尚不清楚。我们使用MarketScan数据库研究了乳果糖和利福昔明对肝硬化患者癌症风险的可能影响。
使用2007年至2017年的Truven Health MarketScan商业索赔数据库进行了一项回顾性队列研究。为每位参与者定义一个索引日期，即肝硬化诊断的最早日期。每位参与者的基线期定义为首次用药日期前的12个月，而研究随访期代表从用药开始到停药的时间段。使用方差分析比较年龄和用药持续时间的所有连续测量值。进行Wald卡方检验以检验研究组之间的关联。
我们的研究共纳入了12409名患者。与其他组相比，仅使用利福昔明的队列发生结肠癌、食管癌和胃癌的风险降低幅度最大。与仅服用乳果糖的患者相比，利福昔明使结肠癌和食管癌的风险分别降低了59.42%和70.37%。乳果糖加利福昔明队列的胰腺癌发生率最高（乳果糖加利福昔明组与仅利福昔明组与仅乳果糖组相比，分别为0.45%对0.24%对0.21%；P<0.0001），肝癌和肝内胆管癌的发生率也最高（分别为11.73%对5.84%对5.49%；P<0.0001）。
与其他研究队列相比，仅使用利福昔明的队列中结肠癌、食管癌和胃癌的发病率显著降低。
