背景:关于长期使用质子泵抑制剂(PPI)药物是否会影响女性癌症风险的确切结论仍存在争议。
目的:我们旨在调查PPI使用与女性癌症风险之间的关联。
方法:以全国人口为基础,巢式病例对照研究在台湾健康与福利数据科学中心的数据库中进行(2000-2016),并与台湾癌症登记处(1979-2016)病理证实的癌症数据相关联.在17年的研究中没有任何癌症诊断的个体作为对照。病例和对照患者按年龄1:4匹配,性别,访问日期。通过调整Charlson合并症指数和药物使用(二甲双胍,阿司匹林,和他汀类药物)。
结果:共发现233,173例女性癌症病例,由135,437名被诊断患有乳腺癌,64,382例宫颈癌,19,580患有子宫内膜癌,13,774例卵巢癌患者.在将每个案例与四个控件匹配后,我们纳入了932,692例对照女性患者。乳腺癌患者的控制数量,宫颈癌,子宫内膜癌,卵巢癌分别为541,748、257,528、78,320和55,096。在20-39岁(调整比值比(aOR):0.69,95CI:0.56-0.84;p&lt;0.001和aOR:0.58,95CI:0.34-0.99;p&lt;0.05)和40-64岁(aOR:0.89,95CI:0.86-0.94,p&lt;分别为0.9501;PPI暴露与40-64岁组宫颈癌和子宫内膜癌风险显著降低相关(分别为aOR:0.79,95CI:0.73-0.86;p<0.0001和aOR:0.72,95CI:0.65-0.81;p<0.0001)。相比之下,在老年妇女中,发现PPI的使用与使用者中的女性癌症无关。
结论:我们的发现,基于现实世界的大数据,可以描述PPI使用和女性癌症风险的全面概述。需要进一步的临床研究来阐明PPI对女性癌症的影响。
Background: Firm conclusions about whether long-term proton pump inhibitor (PPI) drug use impacts female cancer risk remain controversial. Objective: We aimed to investigate the associations between PPI use and female cancer risks. Methods: A nationwide population-based, nested
case-control study was conducted within Taiwan’s Health and Welfare Data Science Center’s databases (2000−2016) and linked to pathologically confirmed cancer data from the Taiwan Cancer Registry (1979−2016). Individuals without any cancer diagnosis during the 17 years of the study served as controls.
Case and control patients were matched 1:4 based on age, gender, and visit date. Conditional logistic regression with 95% confidence intervals (CIs) was applied to investigate the association between PPI exposure and female cancer risks by adjusting for potential confounders such as the Charlson comorbidity index and medication usage (metformin, aspirin, and statins). Results: A total of 233,173 female cancer cases were identified, consisting of 135,437 diagnosed with breast cancer, 64,382 with cervical cancer, 19,580 with endometrial cancer, and 13,774 with ovarian cancer. After matching each
case with four controls, we included 932,692 control female patients. The number of controls for patients with breast cancer, cervical cancer, endometrial cancer, and ovarian cancer was 541,748, 257,528, 78,320, and 55,096, respectively. The use of PPIs was significantly associated with reduced risk of breast cancer and ovarian cancer in groups aged 20−39 years (adjusted odds ratio (aOR): 0.69, 95%CI: 0.56−0.84; p < 0.001 and aOR: 0.58, 95%CI: 0.34−0.99; p < 0.05, respectively) and 40−64 years (aOR: 0.89, 95%CI: 0.86−0.94; p < 0.0001 and aOR: 0.87, 95%CI: 0.75−0.99; p < 0.05, respectively). PPI exposure was associated with a significant decrease in cervical and endometrial cancer risks in the group aged 40−64 years (with aOR: 0.79, 95%CI: 0.73−0.86; p < 0.0001 and aOR: 0.72, 95%CI: 0.65−0.81; p < 0.0001, respectively). In contrast, in elderly women, PPI use was found to be insignificantly associated with female cancers among users. Conclusions: Our findings, based on real-world big data, can depict a comprehensive overview of PPI usage and female cancer risk. Further clinical studies are needed to elucidate the effects of PPIs on female cancers.