Association of widespread body pain with an increased risk of cancer and reduced cancer survival - A prospective, population-based study
Association of widespread body pain with an increased risk of cancer and reduced cancer survival - A prospective, population-based study
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DOI：
10.1002/art.10973
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发表时间：
2003-06-01
影响因子：
--
通讯作者：
Macfarlane, GJ
中科院分区：
文献类型：
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作者：
McBeth, J;Silman, AJ;Macfarlane, GJ
目标。为了确定广泛的身体疼痛是否与癌症发病率的增加和/或癌症存活率的降低有关，因为我们之前的人口调查已经证明了广泛的身体疼痛与随后8年期间癌症死亡率增加2倍之间的关系。1991-1992年期间，英格兰西北部共有6,565名受试者参加了两次健康调查。根据受试者报告的疼痛状态（无疼痛、局部疼痛和广泛疼痛）进行分类，随后进行前瞻性随访，直至1999年12月31日。在随访期间，收集了癌症发病率和癌症患者存活率的信息。原始疼痛状态与癌症发展和癌症生存之间的关系分别用发病率比（IRR）和死亡率比（MRR）表示。所有的分析都根据年龄、性别和研究地点进行了调整，后者是社会经济地位的代理衡量标准。在研究人群中，6331人在参与调查时从未被诊断出患有癌症。在这些受试者中，956人（15%）被归类为广泛性疼痛，3061人（48%）被归类为局部疼痛，2314人（37%）被归类为无疼痛。随访期间共记录了395例首次恶性肿瘤。与无疼痛报告的受试者相比，局部疼痛（IRR 1.19, 95%可信区间[95% CI] 0.94-1.50）和广泛性疼痛（IRR 1.61, 95% CI 1.21-2.13）患者在随访期间的癌症发病率较高。先前报告广泛疼痛的受试者发病率增加与乳腺癌（IRR 3.67, 95% CI 1.39-9.68）密切相关，但也有前列腺癌（IRR 3.46, 95% CI 1.25-9.59）、肠癌（IRR 2.35, 95% CI 0.96-5.77）和肺癌（IRR 2.04, 95% CI 0.96-4.34）。报告广泛疼痛的受试者随后发展为癌症，与先前报告无疼痛的受试者相比，死亡风险增加（MRR 1.82, 95% CI 1.18-2.80）。这种生存率的下降在乳腺癌和前列腺癌患者中最为明显，尽管对部位特异性生存率的影响并不显著。这项研究表明，在人口调查中报告的普遍疼痛与随后癌症发病率的大幅增加和癌症存活率的降低有关。目前对这一现象还没有令人满意的生物学解释，尽管已经确定了几种可能的线索。
Objective. To determine whether reported widespread body pain is related to an increased incidence of cancer and/or reduced survival from cancer, since our previous population surveys have demonstrated a relationship between widespread body pain and a subsequent 2-fold increase in mortality from cancer over an 8-year period.Methods. A total of 6,565 subjects in Northwest England participated in 2 health surveys during 1991-1992. The subjects were classified according to their reported pain status (no pain, regional pain, and widespread pain), and were subsequently followed up prospectively until December 31, 1999. During followup, information was collected on incidence of cancer and survival rates among those developing cancer. Associations between the original pain status, and development of cancer and cancer survival were expressed as the incidence rate ratio (IRR) and mortality rate ratio (MRR), respectively. All analyses were adjusted for age, sex, and study location, the latter being a proxy measure of socioeconomic status.Results. Among the study population, 6,331 had never been diagnosed with cancer at the time of participation in the survey. Of these subjects, 956 (15%) were classified as having widespread pain, 3,061 (48%) as having regional pain, and 2,314 (37%) as having no pain. There were a total of 395 first malignancies recorded during followup. In comparison with subjects reporting no pain, those with regional pain (IRR 1.19, 95% confidence interval [95% CI] 0.94-1.50) and widespread pain (IRR 1.61, 95% CI 1.21-2.13) experienced an excess incidence of cancer during the followup period. The increased incidence among subjects previously reporting widespread pain was related, most strongly, to breast cancer (IRR 3.67, 95% CI 1.39-9.68), but there were also cancers of the prostate (IRR 3.46, 95% CI 1.25-9.59), large bowel (IRR 2.35, 95% CI 0.96-5.77), and lung (IRR 2.04, 95% CI 0.96-4.34). Subjects reporting widespread pain who subsequently developed cancer, in comparison with those previously reporting no pain, had an increased risk of death (MRR 1.82, 95% CI 1.18-2.80). This decreased survival was highest among subjects with cancers of the breast and prostate, although the effects on site-specific survival were nonsignificant.Conclusion. This study has demonstrated that widespread pain reported in population surveys is associated with a substantial subsequent increased incidence of cancer and reduced cancer survival. At present there are no satisfactory biologic explanations for this observation, although several possible leads have been identified.