哮喘后癌症的发病率：两项基于人群的独立队列研究
2020/06/11
摘要
背景：哮喘诊断后发生癌症风险的证据尚无定论。
目的：确定哮喘是否与罹患癌症的风险增加相关。
方法：检查两个独立的基于人群的纵向队列，并使用Cox回归评估风险比。一组包括来自国家健康保险服务国家样本队列（NHIS-NSC；2003-2015年基于索赔的数据）的475197名参与者组成的不匹配队列和75307名倾向得分匹配队列。另一组包括来自Ansan-Ansung队列的5440名参与者（2001年至2014年基于访谈的数据）。
结果：NHIS-NSC配对队列的随访时间为572,740人-年，6885例新诊断为哮喘，68,422例无哮喘。总体上，哮喘患者患癌症的风险增加了75％。在哮喘诊断后的两年内，发生癌症的额外风险最大，在整个随访过程中，这种风险仍然很高。非特应性哮喘的患者比特应性哮喘的患者罹患总体癌症的风险更高。哮喘患者中吸入皮质类固醇的高累积剂量可使肺癌风险降低56％，但对整体癌症风险没有影响。NHIS-NSC非配对队列和Ansan-Ansung队列的结果与NHIS-NSC配对队列的主要结果相似。
结论：在两个不同的韩国队列中，哮喘的发展与随后患癌症的风险增加有关。 我们的发现对哮喘的发病机理及其与癌变的关系提供了更好的理解，并建议临床医生应意识到哮喘患者发生癌症的风险更高。
Incidence of Cancer After Asthma Development: Two Independent Population-Based Cohort Studies.
Ala Woo, Seung Won Lee, Hyun Yong Koh, Mi Ae Kim, Man Yong Han, Dong Keon Yon.
Abstract
BACKGROUND:Evidence regarding the risk of cancer development after asthma diagnosis is controversial and inconclusive.
OBJECTIVE:To determine if asthma is associated with an increased risk for incident cancer.
METHODS:Two independent, population-based, longitudinal cohorts were examined, and estimated hazard ratios were determined using Cox regression. One group consisted of an unmatched cohort of 475,197 participants and a propensity score-matched cohort of 75,307 participants from the National Health Insurance Service-National Sample Cohort (NHIS-NSC; claims-based data from 2003 to 2015). The other group consisted of 5440 participants from the Ansan-Ansung cohort (interview-based data from 2001 to 2014).
RESULTS:The NHIS-NSC matched cohort had 572,740 person-years of follow-up, 6885 people with new asthma diagnoses, and 68,422 people without asthma diagnoses. Adults with asthma had a 75% greater risk of incident cancer overall. The excess risk for incident cancer was greatest during the first 2 years after asthma diagnosis, and this risk remained elevated throughout follow-up. Patients with non-atopic asthma had a greater risk of overall cancer than those with atopic asthma. A high cumulative dose of inhaled corticosteroids among asthma patients was associated with a 56% reduced risk of lung cancer, but had no effect on the risk of overall cancer. The results from the NHIS-NSC unmatched cohort and the Ansan-Ansung cohort were similar to the primary results from the NHIS-NSC matched cohort.
CONCLUSIONS:Asthma development was associated with an increased risk of subsequent cancer in two different Korean cohorts. Our findings provide an improved understanding of the pathogenesis of asthma and its relationship with carcinogenesis, and suggest that clinicians should be aware of the higher risk of incident cancer among asthmatic patients.
背景：哮喘诊断后发生癌症风险的证据尚无定论。
目的：确定哮喘是否与罹患癌症的风险增加相关。
方法：检查两个独立的基于人群的纵向队列，并使用Cox回归评估风险比。一组包括来自国家健康保险服务国家样本队列（NHIS-NSC；2003-2015年基于索赔的数据）的475197名参与者组成的不匹配队列和75307名倾向得分匹配队列。另一组包括来自Ansan-Ansung队列的5440名参与者（2001年至2014年基于访谈的数据）。
结果：NHIS-NSC配对队列的随访时间为572,740人-年，6885例新诊断为哮喘，68,422例无哮喘。总体上，哮喘患者患癌症的风险增加了75％。在哮喘诊断后的两年内，发生癌症的额外风险最大，在整个随访过程中，这种风险仍然很高。非特应性哮喘的患者比特应性哮喘的患者罹患总体癌症的风险更高。哮喘患者中吸入皮质类固醇的高累积剂量可使肺癌风险降低56％，但对整体癌症风险没有影响。NHIS-NSC非配对队列和Ansan-Ansung队列的结果与NHIS-NSC配对队列的主要结果相似。
结论：在两个不同的韩国队列中，哮喘的发展与随后患癌症的风险增加有关。 我们的发现对哮喘的发病机理及其与癌变的关系提供了更好的理解，并建议临床医生应意识到哮喘患者发生癌症的风险更高。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校 )
(J Allergy Clin Immunol. 2020 May 14; S0091-6749(20)30643-6.)
(J Allergy Clin Immunol. 2020 May 14; S0091-6749(20)30643-6.)
Incidence of Cancer After Asthma Development: Two Independent Population-Based Cohort Studies.
Ala Woo, Seung Won Lee, Hyun Yong Koh, Mi Ae Kim, Man Yong Han, Dong Keon Yon.
Abstract
BACKGROUND:Evidence regarding the risk of cancer development after asthma diagnosis is controversial and inconclusive.
OBJECTIVE:To determine if asthma is associated with an increased risk for incident cancer.
METHODS:Two independent, population-based, longitudinal cohorts were examined, and estimated hazard ratios were determined using Cox regression. One group consisted of an unmatched cohort of 475,197 participants and a propensity score-matched cohort of 75,307 participants from the National Health Insurance Service-National Sample Cohort (NHIS-NSC; claims-based data from 2003 to 2015). The other group consisted of 5440 participants from the Ansan-Ansung cohort (interview-based data from 2001 to 2014).
RESULTS:The NHIS-NSC matched cohort had 572,740 person-years of follow-up, 6885 people with new asthma diagnoses, and 68,422 people without asthma diagnoses. Adults with asthma had a 75% greater risk of incident cancer overall. The excess risk for incident cancer was greatest during the first 2 years after asthma diagnosis, and this risk remained elevated throughout follow-up. Patients with non-atopic asthma had a greater risk of overall cancer than those with atopic asthma. A high cumulative dose of inhaled corticosteroids among asthma patients was associated with a 56% reduced risk of lung cancer, but had no effect on the risk of overall cancer. The results from the NHIS-NSC unmatched cohort and the Ansan-Ansung cohort were similar to the primary results from the NHIS-NSC matched cohort.
CONCLUSIONS:Asthma development was associated with an increased risk of subsequent cancer in two different Korean cohorts. Our findings provide an improved understanding of the pathogenesis of asthma and its relationship with carcinogenesis, and suggest that clinicians should be aware of the higher risk of incident cancer among asthmatic patients.
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新冠肺炎住院与非住院患者哮喘患病率及特征分析
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美国成人全国研究中的性激素与哮喘水平
