Thalassaemia and risk of cancer: a population-based cohort study
Thalassaemia and risk of cancer: a population-based cohort study
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DOI：
10.1136/jech-2014-205075
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发表时间：
2015-11-01
影响因子：
6.3
通讯作者：
Kao, Chia-Hung
中科院分区：
文献类型：
--
作者：
Chung, Wei-Sheng;Lin, Chun-Liang;Kao, Chia-Hung
背景调查地中海贫血和癌症之间流行病学关系的研究很少。因此，我们在全国范围内进行了一项纵向队列研究，以确定地中海贫血患者患癌症的风险是否增加。方法利用台湾纵向健康保险数据库的数据，对1998 - 2010年间2655例地中海贫血患者的癌症发病率和风险进行调查。比较队列包括来自无地中海贫血的普通人群的10620人。随访期从地中海贫血诊断之日延长至癌症诊断之日，即2011年12月31日。我们使用Cox比例风险回归模型来分析癌症的风险。结果地中海贫血组和对照组的癌症发病率分别为3.96 /1000人/年和2.60/1000人/年。地中海贫血组的总体癌症发病率比对照组高52%，调整后HR （aHR）为1.54 （95% CI 1.15 ~ 2.07）。地中海贫血患者发生血液恶性肿瘤（aHR=5.32, 95% CI 2.18 ~ 13.0）和腹部癌症（aHR=1.96, 95% CI 1.22 ~ 3.15）的风险明显高于对照组。此外，与未接受输血的患者相比，接受输血的地中海贫血患者患血液恶性肿瘤的风险为9.31倍，患腹部癌症的风险为9.12倍。结论：这项全国性的回顾性队列研究表明，与普通人群相比，地中海贫血患者具有血液恶性肿瘤和腹部癌症的巨大风险。
Background Studies that have investigated the epidemiological relationship between thalassaemia and cancers are scarce. Therefore, we conducted a longitudinal nationwide cohort study to determine whether patients with thalassaemia are at an increased risk of cancer.Methods We investigated the incidence and risk of cancer in 2655 patients diagnosed with thalassaemia between 1998 and 2010 by using data from the Taiwan Longitudinal Health Insurance Database. The comparison cohort comprised 10 620 people from the general population without thalassaemia. The follow-up period extended from the diagnostic date for thalassaemia to the date of a cancer diagnosis, censoring or 31 December 2011. We used Cox proportional hazard regression models to analyse the risks of cancer.Results The incidences of cancer were 3.96 and 2.60/1000 person-years for the thalassaemia and comparison cohorts, respectively. The overall incidence of cancer was 52% higher in the thalassaemia cohort than in the comparison cohort, with an adjusted HR (aHR) of 1.54 (95% CI 1.15 to 2.07). Patients with thalassaemia had a considerably higher risk of haematological malignancy (aHR=5.32, 95% CI 2.18 to 13.0) and abdominal cancer (aHR=1.96, 95% CI 1.22 to 3.15) than did the comparison cohort. Furthermore, patients with thalassaemia with transfusion exhibited a 9.31-fold risk for developing haematological malignancy and a 9.12-fold risk for developing abdominal cancer compared with those who did not receive transfusion.Conclusions This nationwide retrospective cohort study indicates that patients with thalassaemia carried substantial risks of haematological malignancy and abdominal cancer compared with those of the general population.