Graves病患者接受抗甲状腺药物作为初始治疗的癌症风险：一项全国性人群基础分析

Cancer Risks of Patients with Graves' Disease Who Received Antithyroid Drugs as Initial Treatment: A Nationwide Population-Based Analysis

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THYROID

影响因子:6.7

分区:医学1区 Top / 内分泌学与代谢1区

发表日期:2024 Oct

作者: Ju-Yeun Lee, Min Kyung Lee, Jae Hyuk Lee, Kyungsik Kim, Kunho Bae, Seo Young Sohn

DOI: 10.1089/thy.2024.0178

摘要

背景：基于人群的研究关于甲状腺功能亢进与癌症风险之间的关系结果不一致。目前尚不清楚接受抗甲状腺药物（ATDs）作为初始治疗的Graves病（GD）患者的不同癌症风险是否增加。本研究旨在探讨GD患者的癌症风险是否高于对照组。方法：本研究利用韩国国家健康信息数据库进行回顾性队列分析，纳入29,502名≥20岁、接受ATDs作为初始治疗的GD患者，以及57,173名年龄和性别匹配的对照。主要结局为各种癌症的发生率。采用Cox比例风险模型估算癌症风险的风险比（HR）及其置信区间（CI）。此外，根据GD诊断后的随访期进行风险分析，以考虑监测效应。结果：在排除第一年随访后，GD组的胆道癌和胰腺癌（HR：1.41，CI：1.24-1.60）、甲状腺癌（HR：15.51，CI：12.29-19.57）、前列腺癌（HR：1.48，CI：1.28-1.71）及卵巢癌（HR：1.31，CI：1.13-1.52）风险均高于对照组。上述癌症的风险持续存在于随访超过5年后。在随访1至<2年期间，GD患者的甲状腺癌风险更高（HR：19.35，CI：7.66-48.87），而在随访超过2年后风险减弱。排除接受放射性碘治疗的患者后，风险估计仍具有统计学意义。结论：本大规模人群研究显示，GD与胆道及胰腺癌、前列腺癌、卵巢癌和甲状腺癌的发生风险增加有关。尤其是在随访初期，甲状腺癌的风险升高可能与监测效应有关。

Abstract

Background: Population-based studies that examine the associations between hyperthyroidism and cancer risk have yielded inconsistent results. It remains unclear whether the risks of different cancers increase in patients with Graves' disease (GD) who received antithyroid drugs (ATDs) as initial treatment. We aimed to determine whether cancer risk increases in patients with GD, compared with controls. Methods: This nationwide retrospective cohort study utilized data from the National Health Information Database of South Korea. We included 29,502 patients aged >20 years with GD, who received ATDs as initial treatment, and 57,173 age- and sex-matched controls. The primary outcome was the incidence of various types of cancers. Hazard ratios (HRs) with confidence intervals (CIs) for cancer risk were estimated using Cox proportional hazards models. We also analyzed HR by follow-up period since the diagnosis of GD, accounting for surveillance effect. Results: The risk of biliary tract and pancreatic cancers (HR: 1.41, CI: 1.24-1.60), thyroid cancer (HR: 15.51, CI: 12.29-19.57), prostate cancer (HR: 1.48, CI: 1.28-1.71), and ovarian cancer (HR: 1.31, CI: 1.13-1.52) was elevated in the GD group than in the control group even after the first year of follow-up was excluded. The increased risk of these cancers persisted after a follow-up period of more than 5 years. The risk of thyroid cancer in patients with GD was higher during the initial follow-up period (1 to <2 years) (HR: 19.35, CI: 7.66-48.87) compared with that in the follow-up period exceeding 2 years. The cancer risk estimates remained significant after excluding patients with GD who underwent subsequent radioactive iodine therapy. Conclusion: In this large-scale population-based study, GD was associated with increased risks of biliary tract and pancreatic, prostate, ovarian, and thyroid cancers. The increased risk of thyroid cancer, particularly during the initial follow-up period, may be a surveillance effect.