Risk of dementia in colorectal cancer patients receiving chemotherapy: A nationwide cohort study
Risk of dementia in colorectal cancer patients receiving chemotherapy: A nationwide cohort study
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DOI：
10.1016/j.canep.2021.102083
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发表时间：
2022-02-01
影响因子：
2.6
通讯作者：
Hsiao, Pei-Chi
中科院分区：
文献类型：
--
作者：
Chiu, Ru-Huang;Lu, Shiang-Ru;Hsiao, Pei-Chi
背景：关于化疗是否会导致痴呆症，已有研究报道了相互矛盾的证据。本研究旨在探讨化疗是否会增加台湾结直肠癌患者患痴呆症的风险。方法：使用台湾癌症登记处及国家健康保险研究资料库的资料。2007年至2015年期间新诊断为结直肠癌的患者之前没有痴呆或神经退行性疾病病史。根据是否接受化疗，患者被分为化疗组和非化疗组。那些后来患上痴呆症的人使用经过验证的诊断代码进行识别。结果：共纳入76,130例结直肠癌患者，其中化疗组45,872例(60.25%)，非化疗组30,258例(39.75%)。非化疗组的痴呆发生率高于化疗组(3.75%vs.2.40%，p<；0.0001)，但两组间痴呆的风险没有差异(调整后的再分布风险比=0.97，95%可信区间：0.88-1.06，p=0.492)。在分层分析中，化疗是80岁以上患者痴呆的危险因素(调整后的HRSD=1.2 0，95%可信区间：1.0 3~1.4 0，p=0.0190)，而性别、临床癌症分期、合并症、手术和放射治疗对痴呆的风险没有影响。结论：化疗增加了老年结直肠癌患者痴呆的风险，强调了监测化疗后认知功能的必要性。
Background: Studies have reported conflicting evidence regarding whether chemotherapy leads to dementia. This study aimed to determine whether chemotherapy increases dementia risk in Taiwanese patients with colorectal cancer (CRC).Methods: Data from the Taiwan Cancer Registry and National Health Insurance Research Database were used. Patients newly diagnosed as having CRC between 2007 and 2015 without prior history of dementia or neurodegenerative disorders were identified. Based on whether they underwent chemotherapy, patients were divided into chemotherapy and non-chemotherapy groups. Those who later developed dementia were identified using validated diagnostic codes. The Fine and Gray subdistribution hazard model for all-cause dementia with competing risk of death was applied for all patients or each stratified group.Results: A total of 76,130 patients with CRC were included, with 45,872 (60.25%) in the chemotherapy group and 30,258 (39.75%) in the non-chemotherapy group. A higher incidence of dementia was observed in the non-chemotherapy group compared with the chemotherapy group (3.75% vs. 2.40%, p < 0.0001), but the risk of dementia did not differ between the groups (adjusted subdistribution hazard ratio [HRSD] = 0.97, 95% confidence interval [CI]: 0.88-1.06, p = 0.492). In the stratified analysis, chemotherapy was a risk factor for dementia in patients aged > 80 years (adjusted HRSD = 1.20, 95% CI: 1.03-1.40, p = 0.0190), whereas gender, clinical cancer stage, comorbidities, surgery, and radiation therapy had no impact on the risk of dementia.Conclusion: Chemotherapy increased the risk of dementia in elderly patients with CRC, highlighting the necessity to monitor their cognitive function after chemotherapy.