Uchida Amiko M, Schuman Sophia S, Pyne Ashley, Peterson Kathryn, Carlson Marie, Garber John J, Roelstraete Bjorn, Ludvigsson Jonas F
Division of Gastroenterology, Hepatology & Nutrition, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Gastroenterology Research Group, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
United European Gastroenterol J. 2024 Dec;12(10):1378-1387. doi: 10.1002/ueg2.12713. Epub 2024 Nov 20.
Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus. Chronic inflammation has been linked to cancer development. We aimed to study the potential association between EoE and later cancer diagnosis.
In this nationwide population-based cohort study, we identified 1580 individuals with EoE diagnosed between 1990-2017 through Sweden's 28 pathology departments. Up to five general population reference individuals were matched on age and sex (n = 7533). A Cox regression analysis estimated adjusted hazard ratios (aHRs) for cancer up until December 31, 2020. To reduce potential intrafamilial confounding, we also compared EoE individuals with their unaffected siblings.
During a median follow-up of 7 years, 47 individuals with EoE (3.9/1000 person-years) developed cancer versus 183 (3.2/1000 person-years) reference individuals. This corresponded to a non-significant aHR of 1.11 (95% CI = 0.80-1.53). Incidence rates were independent of budesonide and proton-pump inhibitor use. Individuals with EoE however did have an increased risk of esophageal cancer where two EoE versus one reference individual were diagnosed (aHR = 25.20; 95% CI = 2.28-278.80), and also Barrett's esophagus risk was also increased in EoE (HR = 18.18; 95% CI = 6.75-48.95). Non-esophageal gastrointestinal (GI) cancer occurred in 11 EoE versus 24 reference individuals: aHR = 2.03 (95% CI = 0.99-4.18). We found no increased risk of cancers from the skin (EoE n = 10), lung (n = 0), breast (n = 4), or blood (n = 0). Sibling analyses supported these findings.
We did not find any overall association between EoE and cancer development. EoE was associated with esophageal cancer, but this was very rare with wide confidence interval and few cases therefore we urge caution with generalization of these findings.
嗜酸性食管炎（EoE）是一种食管的慢性炎症性疾病。慢性炎症与癌症发生有关。我们旨在研究EoE与后续癌症诊断之间的潜在关联。
在这项基于全国人群的队列研究中，我们通过瑞典的28个病理科确定了1990年至2017年间诊断为EoE的1580名个体。按年龄和性别匹配多达5名普通人群对照个体（n = 7533）。采用Cox回归分析估计截至2020年12月31日的癌症调整风险比（aHRs）。为减少潜在的家族内混杂因素，我们还将EoE个体与其未受影响的兄弟姐妹进行了比较。
在中位随访7年期间，47名EoE个体（3.9/1000人年）发生癌症，而对照个体为183名（3.2/1000人年）。这对应于aHR为1.11（95%CI = 0.80 - 1.53），无统计学意义。发病率与布地奈德和质子泵抑制剂的使用无关。然而，EoE个体患食管癌的风险增加，其中诊断出2例EoE个体与1例对照个体（aHR = 25.20；95%CI = 2.28 - 278.80），并且EoE个体患巴雷特食管的风险也增加（HR = 18.18；95%CI = 6.75 - 48.95）。11例EoE个体与24例对照个体发生非食管胃肠道（GI）癌症：aHR = 2.03（95%CI = 0.99 - 4.18）。我们发现皮肤癌（EoE个体n = 10）、肺癌（n = 0）、乳腺癌（n = 4）或血癌（n = 0）的风险没有增加。兄弟姐妹分析支持了这些发现。
我们未发现EoE与癌症发生之间存在任何总体关联。EoE与食管癌有关，但这种情况非常罕见，置信区间很宽且病例数很少，因此我们敦促在推广这些发现时要谨慎。
