Risk of malignancy in patients with schizophrenia or bipolar disorder - Nested case-control study
Risk of malignancy in patients with schizophrenia or bipolar disorder - Nested case-control study
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DOI：
10.1001/archpsyc.64.12.1368
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发表时间：
2007-12-01
影响因子：
--
通讯作者：
Parker, Chris
中科院分区：
文献类型：
--
作者：
Hippisley-Cox, Julia;Vinogradova, Yana;Parker, Chris
内容：精神分裂症患者患癌症的风险是否与普通人群不同，这一点存在相互矛盾的证据。目的：确定精神分裂症或双相情感障碍患者患6种常见癌症的风险。设计：基于人群的巢式病例对照研究。设置：共有454例QRESEARCH全科医学数据库。参与者：我们分析了6种癌症的40441例发病病例（乳腺癌、结肠癌、直肠癌、胃食管癌、前列腺癌和呼吸系统癌）和每个病例最多5个对照组，按年龄、性别、全科医学和日历时间匹配。与精神分裂症和双相情感障碍相关的癌症风险的比值比（OR），调整吸烟、体重指数、社会经济状况、合并症和处方药物（包括抗精神病药）。对于乳腺癌，我们确定了10 535/50 074例病例/对照;结肠癌，5108/24 458;直肠癌，3248/15 552;胃食管癌，3854/18 477;前列腺癌，10 190/48 748;呼吸道癌，7506/35 981。调整后，精神分裂症患者患结肠癌的风险增加了190%（调整OR，2.90; 95%置信区间[CI]，1.85-4.57），乳腺癌风险边际增加（调整后OR，1.52; 95%CI，1.10-2.11），呼吸道癌症风险降低47%（调整后OR，0.53，95%CI，0.34-0.85）。服用抗精神病药物的精神分裂症患者患结肠癌的风险增加308%（校正OR，4.08; 95%CI，2.43-6.84）。双相情感障碍患者患癌症的风险相似，既没有条件patients after adjustment.Conclusions：精神分裂症患者有显着较高的风险结肠癌和呼吸道癌的风险较低的患者相比，没有精神分裂症调整后的混杂因素。相比之下，患有和不患有双相情感障碍的患者患癌症的风险是相似的，这表明残余混杂不太可能解释这些发现。结肠癌的风险增加在服用抗精神病药物的精神分裂症患者中尤其明显。
Context: There is conflicting evidence on whether people with schizophrenia have a different risk of cancer from that of the general population.Objective: To determine the risk of 6 common cancers in patients with schizophrenia or bipolar disorder.Design: Population-based, nested, case-control study.Setting: A total of 454 practices contributing to the QRESEARCH general practice database.Participants: We analyzed 40 441 incident cases of 6 cancers (breast, colon, rectal, gastroesophageal, prostate, and respiratory) and up to 5 controls per case matched by single year of age, sex, general practice, and calendar time.Main Outcome Measures: Odds ratios (ORs) for cancer risk associated with schizophrenia and bipolar disorder, adjusting for smoking, body mass index, socioeconomic status, comorbidities, and prescribed medications, including antipsychotics.Results: For breast cancer, we identified 10 535/50 074 cases/controls; colon cancer, 5108/24 458; rectal cancer, 3248/15 552; gastroesophageal cancer, 3854/18 477; prostate cancer, 10 190/48 748; and respiratory cancer, 7506/35 981. After adjustment, patients with schizophrenia had a 190% increased colon cancer risk (adjusted OR, 2.90; 95% confidence interval [CI], 1.85-4.57), a marginal increased breast cancer risk (adjusted OR, 1.52; 95% CI, 1.10-2.11), and a 47% decreased respiratory cancer risk (adjusted OR, 0.53, 95% CI, 0.34-0.85). Patients with schizophrenia taking antipsychotics had a 308% increased colon cancer risk (adjusted OR, 4.08; 95% CI, 2.43-6.84). Patients with bipolar disorder had cancer risks similar to patients with neither condition after adjustment.Conclusions: Patients with schizophrenia have a significantly higher risk of colon cancer and a lower risk of respiratory cancer compared with patients without schizophrenia after adjustment for confounders. In contrast, the risks of cancer in patients with and without bipolar disorder are similar, suggesting that residual confounding is unlikely to explain the findings. The increased risk of colon cancer is particularly marked in patients with schizophrenia who take antipsychotic medications.