Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Worldcup-ro 164, Suwon, Gyeonggi-do, 16499, Republic of Korea.
Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, US.
Respir Res. 2024 May 31;25(1):229. doi: 10.1186/s12931-024-02838-7.
COPD is associated with the development of lung cancer. A protective effect of inhaled corticosteroids (ICS) on lung cancer is still controversial. Hence, this study investigated the development of lung cancer according to inhaler prescription and comorbidties in COPD.
A retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database. The development of lung cancer was investigated from the index date to December 31, 2020. This cohort included COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer during screening period or a switch of inhaler after the index date were excluded.
Of the 63,442 eligible patients, 39,588 patients (62.4%) were in the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) group, 22,718 (35.8%) in the ICS/LABA group, and 1,136 (1.8%) in the LABA group. Multivariate analysis showed no significant difference in the development of lung cancer according to inhaler prescription. Multivariate analysis, adjusted for age, sex, and significant factors in the univariate analysis, demonstrated that diffuse interstitial lung disease (DILD) (HR = 2.68; 95%CI = 1.86-3.85), a higher Charlson Comorbidity Index score (HR = 1.05; 95%CI = 1.01-1.08), and two or more hospitalizations during screening period (HR = 1.19; 95%CI = 1.01-1.39), along with older age and male sex, were independently associated with the development of lung cancer.
Our data suggest that the development of lung cancer is not independently associated with inhaler prescription, but with coexisting DILD, a higher Charlson Comorbidity Index score, and frequent hospitalization.
COPD 与肺癌的发生有关。吸入皮质类固醇（ICS）对肺癌的保护作用仍存在争议。因此，本研究根据 COPD 患者的吸入器处方和合并症调查了肺癌的发生情况。
本研究基于韩国健康保险审查和评估服务数据库进行了回顾性队列研究。从索引日期到 2020 年 12 月 31 日调查了肺癌的发生情况。该队列包括新处方吸入器的 COPD 患者（≥40 岁）。在筛选期间有任何癌症史或索引日期后更换吸入器的患者被排除在外。
在 63442 名合格患者中，39588 名患者（62.4%）在长效毒蕈碱拮抗剂（LAMA）和长效β2-激动剂（LABA）组，22718 名患者（35.8%）在 ICS/LABA 组，1136 名患者（1.8%）在 LABA 组。多变量分析显示，根据吸入器处方，肺癌的发生无显著差异。多变量分析，调整年龄、性别和单变量分析中的显著因素，表明弥漫性间质性肺疾病（DILD）（HR=2.68；95%CI=1.86-3.85）、较高的 Charlson 合并症指数评分（HR=1.05；95%CI=1.01-1.08）和筛选期间两次或更多次住院（HR=1.19；95%CI=1.01-1.39），以及年龄较大和男性，与肺癌的发生独立相关。
我们的数据表明，肺癌的发生与吸入器处方无关，而与并存的 DILD、较高的 Charlson 合并症指数评分和频繁住院有关。
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