Exposure to oral bisphosphonates and risk of esophageal cancer.
Exposure to oral bisphosphonates and risk of esophageal cancer.
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DOI：
10.1001/jama.2010.1098
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发表时间：
2010-08-11
期刊：
影响因子：
--
通讯作者：
Murray LJ
中科院分区：
文献类型：
--
作者：
Cardwell CR;Abnet CC;Cantwell MM;Murray LJ
口服双膦酸盐的使用在美国急剧增加。最近的病例报告表明，双膦酸盐的使用与食管癌之间存在联系，但这尚未得到有力的调查。探讨双膦酸盐使用与食管癌的关系。数据摘自英国全科医学研究，用于比较1996年1月至2006年12月期间口服双膦酸盐治疗的患者与未使用这些药物治疗的对照组患者食管癌和胃癌的发病率。从患者临床档案中的相关Read\OXMIS代码中确定癌症。Cox比例风险模型用于计算双膦酸盐使用者与非双膦酸盐使用者相比食道和胃癌风险的风险比（hr）和95% ci，并对潜在混杂因素进行调整。与非双膦酸盐使用者相比，双膦酸盐使用者患食管癌和胃癌的风险比。每个队列有41826名成员；81%女性，平均（SD）年龄70.0（11.4）岁，排除随访时间小于6个月的患者。双膦酸盐组116例食管癌或胃癌（79例食管癌），对照组115例（72例食管癌）。双膦酸盐组和对照组的平均随访时间分别为4.5年和4.4年。使用双膦酸盐组的食管癌和胃癌合并风险没有差异；调整后的HR (95% CI), 0.96（0.74, 1.25）或单独的食管风险；调整后的HR (95% CI), 1.07（0.77, 1.49）。食管癌和胃癌的风险也没有因双膦酸盐摄入量的不同而不同。这项大型研究并没有提供证据表明口服双膦酸盐会增加食管癌（或胃癌）的风险。
Oral bisphosphonate use has increased dramatically in the USA. Recent case reports have suggested a link between bisphosphonate use and esophageal cancer, but this is yet to be robustly investigated. To investigate the association between bisphosphonate use and esophageal cancer. Data were extracted from the UK General Practice Research to compare the incidence of esophageal and gastric cancer in a cohort of patients treated with oral bisphosphonates between January 1996 and December 2006 to a control cohort not treated with these drugs. Cancers were identified from relevant Read\OXMIS codes in the patient’s clinical files. Cox proportional hazards modelling was used to calculate hazard ratios (HRs) and 95% CIs for esophageal and gastric cancer risk in bisphosphonate users compared to non bisphosphonate users, with adjustment for potential confounders. The HR for the risk of esophageal and gastric cancer in the bisphosphonate users compared to the non bisphosphonate users. There were 41,826 members in each cohort; 81% female, mean (SD) age, 70.0 (11.4) years, excluding patients with under 6 months follow-up. 116 esophageal or gastric cancers (79 esophageal) occurred in the bisphosphonate cohort and 115 (72 esophageal) in the control cohort. Mean follow-up time was 4.5 and 4.4 years in the bisphosphonate and control cohorts, respectively. There was no difference in combined esophageal and gastric cancer risk between the cohorts for any bisphosphonate use; adjusted HR (95% CI), 0.96 (0.74, 1.25) or esophageal risk alone; adjusted HR (95% CI), 1.07 (0.77, 1.49). There was also no difference in esophageal or gastric cancer risk by level of bisphosphonate intake. This large study does not provide evidence for an increased risk of esophageal (or gastric) cancer in persons using oral bisphosphonates.
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