背景:糖尿病患者患各种癌症的风险明显更高,这两种疾病之间潜在的生物学联系还没有完全了解。
方法:这是一项全国范围的纵向回顾性队列研究,一项研究设计,使我们能够以大量的样本量在延长的时间内检查癌症发展的自然过程。最初,3,111,975和22,208,395名年龄≥20岁的糖尿病患者,分别,按年龄匹配,性别,和Charlson合并症指数.最终,每组选择1,751,457例患者。分析了糖尿病视网膜病变(DR)(n=380,822)和无DR(n=380,822)以及增殖性DR(PDR)(n=141,150)和非增殖性DR(NPDR)(n=141,150)的分层人群在这项研究中。主要结果指标是在随访期间首次诊断出癌症。
结果:我们观察到癌症总发病率[风险比(HR),1.20;p<0.001]在糖尿病队列与非糖尿病队列中。对于肝癌和胰腺癌观察到最高的HR。口服观察到风险适度增加,结肠,胆囊,生殖(女性),肾,和脑癌。此外,胃病风险显著增加,皮肤,软组织,女性乳房,尿路癌(肾癌除外)以及淋巴和造血系统恶性肿瘤。分层分析显示,DR队列中的总癌症发病率明显高于非DR队列(HR,1.31;p<0.001),与NPDR队列相比,PDR队列的风险有临界增加(HR,1.13;p=0.001)。
结论:这项研究提供了大规模,全国范围内,基于人群的证据表明,糖尿病与随后发展为总癌症和特定部位癌症的风险增加独立相关。值得注意的是,当DR发展时,这种风险可能会进一步增加.
BACKGROUND: Individuals with diabetes have a significantly higher risk of developing various forms of cancer, and the potential biological links between these two diseases are not completely understood.
METHODS: This was a longitudinal retrospective nationwide cohort study, a study design that allows us to examine the natural course of cancer development over an extended period of time with a large sample size. Initially, 3,111,975 and 22,208,395 eligible patients aged ≥ 20 years with and without diabetes, respectively, were matched by age, sex, and the Charlson comorbidity index. Ultimately, 1,751,457 patients were selected from each group. Stratified populations for diabetic retinopathy (DR) (n = 380,822) and without DR (n = 380,822) as well as proliferative DR (PDR) (n = 141,150) and non-proliferative DR (NPDR) (n = 141,150) were analyzed in this study. The main outcome measure was the first-time diagnosis of cancer during the follow-up period.
RESULTS: We observed a 20% higher risk of total cancer incidence [hazard ratios (HR), 1.20; p < 0.001] in the diabetes cohort compared to the non-diabetes cohort. The highest HR was observed for liver and pancreas cancers. Moderately increased risks were observed for oral, colon, gallbladder, reproductive (female), kidney, and brain cancer. Furthermore, there was a borderline significantly increased risk of stomach, skin, soft tissue, female breast, and urinary tract (except kidney) cancers and lymphatic and hematopoietic malignancies. The stratified analysis revealed that the total cancer incidence was significantly higher in the DR cohort compared to the non-DR cohort (HR, 1.31; p < 0.001), and there was a borderline increased risk in the PDR cohort compared to the NPDR cohort (HR, 1.13; p = 0.001).
CONCLUSIONS: This study provides large-scale, nationwide, population-based evidence that diabetes is independently associated with an increased risk of subsequent development of total cancer and cancer at specific sites. Notably, this risk may further increase when DR develops.