The risk of amyotrophic lateral sclerosis after cancer in US elderly adults: A population-based prospective study
The risk of amyotrophic lateral sclerosis after cancer in US elderly adults: A population-based prospective study
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DOI：
10.1002/ijc.28795
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发表时间：
2014-10-01
影响因子：
6.4
通讯作者：
Pfeiffer, Ruth M.
中科院分区：
文献类型：
--
作者：
Freedman, D. Michal;Wu, Jincao;Pfeiffer, Ruth M.
虽然流行病学研究已经检查了肌萎缩侧索硬化症（ALS）与癌症的风险，但没有一项是使用ALS事件并调整医疗监测的大型人群研究。为了解决这些局限性，使用了与医疗保险索赔数据相关的监测、流行病学和最终结果（SEER）计划（1992-2005）中的所有首次原发性癌症病例。病例从癌症诊断到ALS诊断的最早日期，医疗保险索赔数据的中断，死亡，85岁或2005年12月31日。来自SEER地区5%随机医疗保险样本的对照组，他们无癌症并如上所述进行审查，或直到选择癌症诊断。ALS结果来自医疗索赔。使用比例风险模型估计ALS风险比（HR），使用年龄作为时间尺度，调整性别，种族和医生访视，并对出生年份和SEER登记的基线风险进行分层。在癌症患者中共确定了303例ALS病例（2，154，062人年），而在参考人群中有246例ALS病例（2，467，634人年）。癌症和ALS之间没有总体关系（HR = 0.99; 95% CI = 0.81-1.22），也没有性别或种族。除了白血病诊断后第一年ALS风险升高外，在校正多重比较后，特定部位癌症与ALS之间的关系为零。癌症诊断与ALS事件的总体风险无关。白血病后的短期ALS风险可能反映了筛查或报告错误。
Although epidemiologic studies have examined the risk of amyotrophic lateral sclerosis (ALS) in relation to cancer, none have been large population-based studies using incident ALS and adjusting for medical surveillance. Addressing those limitations, all first primary cancer cases from the Surveillance, Epidemiology and End Results (SEER) Program (1992-2005), linked to Medicare claims data were used. Cases were followed from cancer diagnosis until the earliest date of ALS diagnosis, a break in Medicare claims data, death, age 85 or December 31, 2005. A comparison group from a 5% random Medicare sample in the SEER areas who were cancer-free and censored as above, or until a cancer diagnosis were selected. ALS outcomes were derived from medical claims. The proportional hazards models to estimate ALS hazard ratios (HRs), using age as the time scale, adjusting for sex, race and physician visits, and stratifying the baseline hazard on birth year and SEER registry were used. A total of 303 ALS cases were ascertained in cancer patients (2,154,062 person-years) compared with 246 ALS cases (2,467,634 person-years) in the reference population. There was no overall relationship between cancer and ALS (HR = 0.99; 95% CI = 0.81-1.22), nor by gender or race. Except for an elevated ALS risk in the first year after a leukemia diagnosis, the relationship between site-specific cancers and ALS was null after correcting for multiple comparisons. Having a cancer diagnosis was not associated with an overall risk of incident ALS. The short-term ALS risk after leukemia may reflect screening or reporting errors.