Feodoroff Maija, Harjutsalo Valma, Mäkimattila Sari, Groop Per-Henrik
Folkhälsan Institute of Genetics, Folkhälsan Research Centre, Helsinki, Finland.
Department of Nephrology, University of Helsinki and Helsinki University Hospital, Finland.
Lancet Reg Health Eur. 2024 Mar 16;40:100884. doi: 10.1016/j.lanepe.2024.100884. eCollection 2024 May.
Individuals with type 1 diabetes (T1D) have been reported to have increased overall risk of cancer. In addition, individuals with a kidney transplant/transplantation (KT) have markedly increased cancer risk due to chronic use of immunosuppressive agents. However, it has not been elucidated whether the observed excess cancer risk is related to KT or whether diabetic kidney disease (DKD) per se is a risk factor for cancer in individuals with T1D.
The study included 5035 individuals from the Finnish Diabetic Nephropathy Study (FinnDiane) and 14,061 control individuals without diabetes. We assessed the standardized incidence ratios (SIRs) for cancers in individuals with T1D compared to controls according to DKD status. Cox regression analyses were used to identify potential risk factors for cancer in individuals with type 1 diabetes.
The SIR for overall cancer for all participants was 1.14 (1.05-1.24), for participants without KT 0.92 (0.83-1.01) and for participants with KT 4.78 (4.02-5.64). Participants without KT had in fact a reduced risk of prostate cancer with a SIR of 0.54 (0.37-0.76), cancer of urinary organs 0.41 (0.21-0.73) and respiratory and intrathoracic organs, 0.62 (0.38-0.97). Participants with KT had on the contrary an increased risk of non-melanoma skin cancer, SIR 14.50 (10.99-18.86), cancer in the lymphoid and hematopoietic tissue 5.38 (2.99-8.96), mouth or pharynx 5.13 (2.08-10.66), melanoma 5.12 [2.38-9.72]) and respiratory and intrathoracic organs 2.77 (1.21-5.49). The risk of thyroid cancer was increased both in participants without KT, SIR 2.14 (1.39-3.16) and with KT 5.30 (1.68-12.78).
The excess overall cancer risk in individuals with type 1 diabetes is only seen in KT recipients and in thyroid cancer. The individuals without KT seem to have a decreased risk of some forms of cancer.
Folkhälsan Research Foundation, Academy of Finland [316664], Wilhelm and Else Stockmann Foundation, Liv och Hälsa Society, Novo Nordisk Foundation [NNF OC0013659], Finnish Foundation for Cardiovascular Research, Finnish Diabetes Research Foundation, Medical Society of Finland, Sigrid Jusélius Foundation, and Helsinki University Hospital Research Funds [TYH2018207 and TYH 2020305].
据报道，1型糖尿病（T1D）患者患癌的总体风险有所增加。此外，肾移植受者由于长期使用免疫抑制剂，患癌风险显著增加。然而，目前尚不清楚观察到的癌症风险增加是与肾移植有关，还是糖尿病肾病（DKD）本身就是T1D患者患癌的危险因素。
该研究纳入了芬兰糖尿病肾病研究（FinnDiane）的5035名个体以及14061名无糖尿病的对照个体。我们根据DKD状态评估了T1D患者与对照相比患癌的标准化发病比（SIR）。采用Cox回归分析确定1型糖尿病患者患癌的潜在危险因素。
所有参与者的总体癌症SIR为1.14（1.05 - 1.24），未进行肾移植的参与者为0.92（0.83 - 1.01），进行肾移植的参与者为4.78（4.02 - 5.64）。未进行肾移植的参与者实际上患前列腺癌的风险降低，SIR为0.54（0.37 - 0.76），泌尿系统癌症为0.41（0.21 - 0.73），呼吸和胸腔器官癌症为0.62（0.38 - 0.97）。相反，进行肾移植的参与者患非黑色素瘤皮肤癌的风险增加，SIR为14.50（10.99 - 18.86），淋巴和造血组织癌症为5.38（2.99 - 8.96），口腔或咽部癌症为5.13（2.08 - 10.66），黑色素瘤为5.12 [2.38 - 9.72]），呼吸和胸腔器官癌症为2.77（1.21 - 5.49）。未进行肾移植的参与者和进行肾移植的参与者患甲状腺癌的风险均增加，SIR分别为2.14（1.39 - 3.16）和5.30（1.68 - 12.78）。
1型糖尿病患者总体患癌风险增加仅见于肾移植受者和甲状腺癌。未进行肾移植的个体似乎某些类型癌症的风险降低。
芬兰健康与福利研究所研究基金会、芬兰科学院[316664]、威廉和埃尔丝·施托克曼基金会、生命与健康协会、诺和诺德基金会[NNF OC0013659]、芬兰心血管研究基金会、芬兰糖尿病研究基金会、芬兰医学协会、西格丽德·尤塞利乌斯基金会以及赫尔辛基大学医院研究基金[TYH2018207和TYH 2020305]。
