阿片类药物使用相关障碍患者的癌症发病率和死亡率增加：一项全国性队列研究。

Increased cancer incidence and mortality among people with opioid use-related disorders: A nation-wide cohort study.

机构信息

Manifestsenteret, Røyken, Norway.

Niuvanniemi Hospital, Kuopio, Finland.

出版信息

Addiction. 2024 Sep;119(9):1575-1584. doi: 10.1111/add.16524. Epub 2024 May 22.

DOI:10.1111/add.16524

PMID:38775233

Abstract

BACKGROUND AND AIMS

Studies on cancer incidence and mortality among people with opioid use-related disorders are lacking. We aimed to measure cancer-specific incidence, mortality and survival among people diagnosed with opioid use-related disorders in Norway during 2010-18.

DESIGN AND SETTING

This was a cohort study conducted in Norway during 2010-18.

PARTICIPANTS

Individuals (n = 20 710) diagnosed with opioid use-related disorders.

MEASUREMENTS

We conducted a cohort study utilizing a data-linkage of national health and population registers. Information on opioid use-related disorders was extracted from specialized healthcare, malignancies from the Cancer Registry of Norway and deaths from Cause of Death Registry. Cancer incidence and mortality were compared with the general population by calculating sex-specific age-standardized incidence (SIR) and mortality (SMR) ratios. One-year survival rates were computed.

FINDINGS

Compared with the general population, people with opioid use-related disorders were at an increased risk of developing cancer overall [SIR = 1.2, 95% confidence interval (CI) = 1.1-1.3] with a higher than twofold cancer mortality rate (SMR = 2.3, 95% CI = 2.0-2.7). Excess risk was observed for liver (12.6, 95% CI = 9.1-17.0), larynx (4.7, 95% CI = 1.7-10.2), lung (3.5, 95% CI = 2.8-4.3) and pancreas cancer (2.6, 95% CI = 1.6-4.0), whereas reduced risk was found for melanoma (0.5, 95% CI = 0.3-0.9), breast (0.6, 95% CI = 0.4-0.9) and prostate cancers (0.3, 95% CI = 0.1-0.4). Site-specific SMRs were significantly elevated for liver (12.3, 95% CI = 8.5-17.2), lung (3.9, 95% CI = 3.0-5.0), pancreas (3.0, 95% CI = 1.7-4.8) and colon cancers (1.9, 95% CI = 1.1-3.1). The average 1-year survival rate after a cancer diagnosis was low in liver, pancreas and colon cancer, ranging from 10 to 15% less than that of the general population.

CONCLUSIONS

In Norway, cancer incidence and cancer-related mortality appear to be elevated among individuals with opioid use-related disorders.

摘要

背景和目的

目前缺乏关于阿片类药物使用障碍患者癌症发病率和死亡率的研究。本研究旨在评估 2010-2018 年挪威阿片类药物使用障碍患者的癌症特异性发病率、死亡率和生存率。

设计和地点

这是一项在挪威进行的队列研究，时间为 2010-2018 年。

参与者

诊断为阿片类药物使用障碍的个体（n=20710）。

测量

我们进行了一项队列研究，利用国家卫生和人口登记数据进行了链接。阿片类药物使用障碍相关信息从专门的医疗保健中提取，恶性肿瘤信息从挪威癌症登记处获取，死亡信息从死因登记处获取。通过计算特定性别年龄标准化发病率（SIR）和死亡率（SMR）比值，将癌症发病率和死亡率与普通人群进行比较。计算了 1 年生存率。

结果

与普通人群相比，阿片类药物使用障碍患者的总体癌症发病风险增加（SIR=1.2，95%置信区间[CI]：1.1-1.3），癌症死亡率高出两倍以上（SMR=2.3，95%CI：2.0-2.7）。观察到肝脏（12.6，95%CI：9.1-17.0）、喉（4.7，95%CI：1.7-10.2）、肺（3.5，95%CI：2.8-4.3）和胰腺（2.6，95%CI：1.6-4.0）癌症的风险增加，而黑色素瘤（0.5，95%CI：0.3-0.9）、乳腺癌（0.6，95%CI：0.4-0.9）和前列腺癌（0.3，95%CI：0.1-0.4）的风险降低。肝脏（12.3，95%CI：8.5-17.2）、肺（3.9，95%CI：3.0-5.0）、胰腺（3.0，95%CI：1.7-4.8）和结肠（1.9，95%CI：1.1-3.1）癌症的部位特异性 SMR 显著升高。癌症诊断后 1 年的平均生存率在肝癌、胰腺癌和结肠癌较低，比普通人群低 10%至 15%。