接受抗甲状腺药物作为初始治疗的坟墓疾病患者的癌症风险：一种基于人群的分析
Cancer Risks of Patients with Graves' Disease Who Received Antithyroid Drugs as Initial Treatment: A Nationwide Population-Based Analysis
影响因子:6.70000
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
摘要
背景：基于人群的研究，研究甲状腺功能亢进症与癌症风险之间的关联已产生不一致的结果。尚不清楚接受抗甲状腺药物（ATD）作为初始治疗的坟墓疾病患者（GD）的不同癌症的风险是否会增加。我们旨在确定与对照组相比，GD患者的癌症风险是否增加。方法：这项全国回顾性队列研究利用了韩国国家健康信息数据库的数据。我们包括29,502名患有GD> 20岁的患者，他们接受了ATD作为初始治疗，以及57,173岁的年龄和性别匹配的对照。主要结果是各种类型的癌症的发生率。使用COX比例危害模型估算了具有置信区间（CI）的危险比（HRS）。自从GD诊断以来，我们还通过随访期分析了人力资源，这会考虑监视效应。 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即使在随访的第一年之后，GD组也比对照组中的组比。经过5年以上的随访期，这些癌症的风险增加持续存在。在最初的随访期（1至<2年）（HR：19.35，CI：7.66-48.87）中，GD患者患甲状腺癌的风险较高，而在超过2年的随访期内。在排除接受随后的放射性碘治疗的GD患者之后，癌症风险估计仍然很大。结论：在这项基于人群的大规模研究中，GD与胆道和胰腺，前列腺，卵巢和甲状腺癌的风险增加有关。甲状腺癌的风险增加，尤其是在最初的随访期间，可能是一种监视效果。
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.