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Abstract：
BACKGROUND: COPD is associated with the development of lung cancer. A protective effect of inhaled corticosteroids (ICS) on lung cancer is still controversial. Hence, this study investigated the development of lung cancer according to inhaler prescription and comorbidties in COPD.
METHODS: A retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database. The development of lung cancer was investigated from the index date to December 31, 2020. This cohort included COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer during screening period or a switch of inhaler after the index date were excluded.
RESULTS: Of the 63,442 eligible patients, 39,588 patients (62.4%) were in the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) group, 22,718 (35.8%) in the ICS/LABA group, and 1,136 (1.8%) in the LABA group. Multivariate analysis showed no significant difference in the development of lung cancer according to inhaler prescription. Multivariate analysis, adjusted for age, sex, and significant factors in the univariate analysis, demonstrated that diffuse interstitial lung disease (DILD) (HR = 2.68; 95%CI = 1.86-3.85), a higher Charlson Comorbidity Index score (HR = 1.05; 95%CI = 1.01-1.08), and two or more hospitalizations during screening period (HR = 1.19; 95%CI = 1.01-1.39), along with older age and male sex, were independently associated with the development of lung cancer.
CONCLUSIONS: Our data suggest that the development of lung cancer is not independently associated with inhaler prescription, but with coexisting DILD, a higher Charlson Comorbidity Index score, and frequent hospitalization.
METHODS: A retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database. The development of lung cancer was investigated from the index date to December 31, 2020. This cohort included COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer during screening period or a switch of inhaler after the index date were excluded.
RESULTS: Of the 63,442 eligible patients, 39,588 patients (62.4%) were in the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) group, 22,718 (35.8%) in the ICS/LABA group, and 1,136 (1.8%) in the LABA group. Multivariate analysis showed no significant difference in the development of lung cancer according to inhaler prescription. Multivariate analysis, adjusted for age, sex, and significant factors in the univariate analysis, demonstrated that diffuse interstitial lung disease (DILD) (HR = 2.68; 95%CI = 1.86-3.85), a higher Charlson Comorbidity Index score (HR = 1.05; 95%CI = 1.01-1.08), and two or more hospitalizations during screening period (HR = 1.19; 95%CI = 1.01-1.39), along with older age and male sex, were independently associated with the development of lung cancer.
CONCLUSIONS: Our data suggest that the development of lung cancer is not independently associated with inhaler prescription, but with coexisting DILD, a higher Charlson Comorbidity Index score, and frequent hospitalization.
摘要：
背景：COPD与肺癌的发生发展有关。吸入性糖皮质激素（ICS）对肺癌的保护作用仍存在争议。因此，这项研究根据吸入剂处方和COPD合并症调查了肺癌的发展。
方法：根据韩国健康保险审查和评估服务数据库进行了一项回顾性队列研究。从索引日期到2020年12月31日，对肺癌的发展进行了调查。该队列包括COPD患者（≥40岁），使用新的吸入器处方。排除在筛查期间有任何癌症病史或在索引日期后更换吸入器的患者。
结果：在63,442名合格患者中，39,588例患者（62.4％）为长效毒蕈碱拮抗剂（LAMA）和长效β2激动剂（LABA）组，ICS/LABA组22,718（35.8%），和1,136(1.8%)的LABA组。多因素分析显示，根据吸入剂处方，肺癌的发展无明显差异。多变量分析，根据年龄调整，性别,以及单变量分析中的重要因素，证明弥漫性间质性肺病（DILD）（HR=2.68；95CI=1.86-3.85），Charlson合并症指数得分较高（HR=1.05；95CI=1.01-1.08），筛查期间两次或两次以上住院（HR=1.19;95CI=1.01-1.39），随着年龄和男性，与肺癌的发生发展独立相关。
结论：我们的数据表明，肺癌的发展与吸入剂处方无关，但是有了共存的DILD，Charlson合并症指数得分较高,经常住院。
方法：根据韩国健康保险审查和评估服务数据库进行了一项回顾性队列研究。从索引日期到2020年12月31日，对肺癌的发展进行了调查。该队列包括COPD患者（≥40岁），使用新的吸入器处方。排除在筛查期间有任何癌症病史或在索引日期后更换吸入器的患者。
结果：在63,442名合格患者中，39,588例患者（62.4％）为长效毒蕈碱拮抗剂（LAMA）和长效β2激动剂（LABA）组，ICS/LABA组22,718（35.8%），和1,136(1.8%)的LABA组。多因素分析显示，根据吸入剂处方，肺癌的发展无明显差异。多变量分析，根据年龄调整，性别,以及单变量分析中的重要因素，证明弥漫性间质性肺病（DILD）（HR=2.68；95CI=1.86-3.85），Charlson合并症指数得分较高（HR=1.05；95CI=1.01-1.08），筛查期间两次或两次以上住院（HR=1.19;95CI=1.01-1.39），随着年龄和男性，与肺癌的发生发展独立相关。
结论：我们的数据表明，肺癌的发展与吸入剂处方无关，但是有了共存的DILD，Charlson合并症指数得分较高,经常住院。
