丙型肝炎与结肠癌和直肠癌的不同代谢关联：一项基于全国人口的9年队列研究。
Different Metabolic Associations of Hepatitis C With Colon and Rectal Cancers: A 9-Year Nationwide Population-Based Cohort Study.
作者信息
Chen Chun-Wei, Shan Cheng Jur-, Chen Tsung-Hsing, Kuo Chia-Jung, Ku Hsin-Ping, Chien Rong-Nan, Chang Ming-Ling
机构信息
Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan.
Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taiwan; Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Clin Colorectal Cancer. 2025 Mar;24(1):39-47.e1. doi: 10.1016/j.clcc.2024.08.005. Epub 2024 Sep 6.
BACKGROUND
Whether HCV infection is associated with colorectal cancer (CRC) development remains inconclusive.
METHODS
A nationwide population-based cohort study of the Taiwan National Health Insurance Research Database was conducted.
RESULTS
From 2003 to 2012, 1:2:2 propensity score-matched HCV-treated [interferon-based therapy ≥ 6 months, surveys for CRC (n = 9017), colon cancer (CC) (n = 9,022) and rectal cancer (RC) (n = 9,033), HCV-untreated and HCV-uninfected cohorts CRC (n = 18034), CC (n = 18,044) and RC (n = 18,066) were enrolled. The HCV-uninfected cohort had the lowest cumulative incidence of CRC (0.117%; 95% CI: 0.062%-0.207%), whereas the HCV-treated (0.966%; 0.375-2.122%) and HCV-untreated (0.807%; 0.485%-1.280%) cohorts had similar incidences (P = .0662); HCV infection [reference: HCV-untreated cohort, HCV-treated: hazard ratio (HR): 0.598; 95% CI HR: 0.337-1.059; HCV-uninfected: 0.250; 0.138-0.456] and age ≥ 49 years (3.128;1.751-5.59) were associated with CRC development. The HCV-untreated cohort had the highest cumulative incidence of CC (0.883%; 0.371-1.839%), while HCV-treated (0.478%; 0.110-1.518%) and HCV-uninfected cohorts (0.147%; 0.071-0.284%) had similar incidences (P = .4853); HCV infection (HCV-treated: 0.474; 0.232-0.971; HCV-uninfected: 0.338; 0.184-0.62), male sex (2.18; 1.301-3.654), age≥ 49 years (4.818; 2.123-10.936) and diabetes (1.983; 1.205-3.262) were associated with CC development. A higher RC cumulative incidence was noted in the HCV-untreated cohort (0.332%; 0.151-0.664%) than in the HCV-uninfected cohort (0.116%; 0.054-0.232%) (P = .0352); HCV infection (HCV-treated: 0.691; 0.295-1.617; HCV-uninfected: 0.424; 0.207-0.867), age ≥ 49 years (3.745, 1.576-8.898) and stroke (3.162; 1.366-7.322) were associated with RC development.
CONCLUSIONS
The baseline associations were HCV infection and age ≥ 49 years with CRC; male sex and diabetes with CC; and stroke with RC. Anti-HCV therapy might reverse the risk of HCV-related CC but not RC.
背景
丙型肝炎病毒（HCV）感染是否与结直肠癌（CRC）的发生相关仍尚无定论。
方法
基于台湾国民健康保险研究数据库开展了一项全国性的队列研究。
结果
2003年至2012年期间，按照1:2:2倾向评分匹配，纳入了接受HCV治疗的患者（基于干扰素的治疗≥6个月，接受CRC调查的有9017例、结肠癌（CC）9022例和直肠癌（RC）9033例）、未接受HCV治疗的患者以及未感染HCV的患者，其中CRC患者18034例、CC患者18044例、RC患者18066例。未感染HCV的队列CRC累积发病率最低（0.117%；95%置信区间：0.062% - 0.207%），而接受HCV治疗的队列（0.966%；0.375 - 2.122%）和未接受HCV治疗的队列（0.807%；0.485% - 1.280%）发病率相似（P = 0.0662）；HCV感染（参照：未接受HCV治疗的队列，接受HCV治疗的：风险比（HR）：0.598；95%置信区间HR：0.337 - 1.059；未感染HCV的：0.250；0.138 - 0.456）以及年龄≥49岁（3.128；1.751 - 5.59）与CRC发生相关。未接受HCV治疗的队列CC累积发病率最高（0.883%；0.371 - 1.839%），而接受HCV治疗的队列（0.478%；0.110 - 1.518%）和未感染HCV队列（0.147%；0.071 - 0.284%）发病率相似（P = 0.4853）；HCV感染（接受HCV治疗的：0.474；0.232 - 0.971；未感染HCV的：0.338；0.184 - 0.62）、男性（2.18；1.301 - 3.654）、年龄≥49岁（4.818；2.123 - 10.936）以及糖尿病（1.983；1.205 - 3.262）与CC发生相关。未接受HCV治疗的队列RC累积发病率高于未感染HCV的队列（0.332%；0.151 - 0.664%比0.116%；0.054 - 0.232%）（P = 0.0352）；HCV感染（接受HCV治疗的：0.691；0.295 - 1.617；未感染HCV的：0.424；0.207 - 0.867）、年龄≥49岁（3.745，1.576 - 8.898）以及中风（3.162；1.366 - 7.322）与RC发生相关。
结论
基线关联因素为HCV感染和年龄≥49岁与CRC相关；男性和糖尿病与CC相关；中风与RC相关。抗HCV治疗可能会逆转HCV相关CC的风险，但不能逆转RC的风险。
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