Antidepressant Use and Risk of Colorectal Cancer in the Women's Health Initiative.
Antidepressant Use and Risk of Colorectal Cancer in the Women's Health Initiative.
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DOI：
10.1158/1055-9965.epi-17-1035
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发表时间：
2018-08
期刊：
影响因子：
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通讯作者：
Reeves KW
中科院分区：
文献类型：
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作者：
Kiridly-Calderbank JF;Sturgeon SR;Kroenke CH;Reeves KW
之前的一些研究报告称，使用抗抑郁（AD）药物，特别是选择性血清素再摄取抑制剂（SSRI）的个体，结直肠癌的风险降低。然而，大多数研究在分析中并未考虑抑郁症或其他混杂因素的潜在作用。我们前瞻性地收集了 145,190 名女性健康倡议参与者的数据，其中诊断出 2,580 例结直肠癌病例。在基线和后续研究访问中评估 AD 使用和抑郁症状。使用对抑郁症状和其他协变量进行调整的 Cox 比例风险回归模型来估计 AD 使用与结直肠癌之间关联的风险比 (HR) 和 95% 置信区间 (CI)。基线时有 6.9% 的参与者报告使用 AD，其中 SSRI 是最常见的 AD 类别。在包括抑郁症状学调整在内的多变量分析中，我们观察到 AD 总体使用（HR 0.90，95% CI 0.75–1.09）或特定 SSRIs（HR 1.08，95% CI 0.85–1.37）与结直肠癌风险之间没有统计学显着关联。使用三环类抗抑郁药观察到结直肠癌风险显着降低（HR 0.76，95% CI 0.56-1.04）。严重抑郁症状与结直肠癌风险增加 20% 独立相关（HR 1.21，95% CI 1.09-1.48）。结肠癌和直肠癌的单独评估结果相似。我们没有观察到 AD 使用（总体或按治疗类别）与结直肠癌风险之间存在关联的证据。这些结果表明 AD 可能无法用作结直肠癌的化学预防剂。
Some prior studies have reported reduced colorectal cancer risk among individuals using antidepressant (AD) medications, especially selective serotonin reuptake inhibitors (SSRIs). Yet, most studies have not considered the potential role of depression or other confounders in their analyses. We utilized prospectively collected data from 145,190 participants in the Women’s Health Initiative, among whom 2,580 incident colorectal cancer cases were diagnosed. AD use and depressive symptoms were assessed at baseline and follow-up study visits. Cox proportional hazards regression models with adjustment for depressive symptoms and other covariates were utilized to estimate hazard ratios (HR) and 95% confidence intervals (CIs) for associations between AD use and colorectal cancer. AD use was reported by 6.9% of participants at baseline, with SSRIs the most common class of AD used. In multivariable analyses, including adjustment for depressive symptomology, we observed no statistically significant association between AD use overall (HR 0.90, 95% CI 0.75–1.09) or with SSRIs specifically (HR 1.08, 95% CI 0.85–1.37) and colorectal cancer risk. A borderline significant reduction in colorectal cancer risk was observed for use of tricyclic antidepressants (HR 0.76, 95% CI 0.56–1.04). Severe depressive symptoms were independently associated with a 20% increased risk of colorectal cancer (HR 1.21, 95% CI 1.09–1.48). Results were similar for separate evaluations of colon and rectal cancer. We observed no evidence of an association between AD use, overall or by therapeutic class, and colorectal cancer risk. These results suggest that ADs may not be useful as chemopreventive agents for colorectal cancer.