長期使用NSAIDs可能減少皮膚癌風險


  【24drs.com】根據線上發表於5月29日癌症期刊的人口基礎、案例控制研究,使用非類固醇抗發炎藥物(NSAIDs)可能會減少發生鱗狀上皮細胞癌(SCC)或惡性黑色素瘤(MM)的風險。
  
  整體而言,相較於未使用NSAIDs者(≦2次處方),使用者(>2次處方)和SCC風險(發生率比率[IRR],0.85;95%信心區間[CI],0.76 - 0.94)與MM風險(IRR,0.87;95% CI,0.80 - 0.95)降低有關。特別是長期使用(≧7年)和高度使用(整個使用期間有>25%的時間有開立處方),雖然使用NSAID和基底細胞癌(BCC)風險降低無關(IRR,0.97;95% CI,0.93 - 1.01),頭部外之部位的BCC風險與長期使用(IRR,0.85;95% CI,0.76 - 0.95)和高度使用(IRR,0.79;95% CI,0.69 - 0.91)有關。
  
  丹麥Aarhus大學醫院臨床流行病學科Sigrun Alba Johannesdottir等人寫道,NSAIDs的效果隨著使用期間和強度增加,反映出發生在致癌病變時啟動的累積生物效應(即劑量反應效果)。
  
  研究者指出,和風險降低有關的NSAIDs主要是非選擇性NSAIDs和比較舊的cyclooxygenase(COX)-2抑制劑(diclofenac、etodolac和meloxicam)。和其他研究不同的是,我們的研究並不支持新型COX-2抑制劑和皮膚癌或整體NSAIDs和BCC之間的關聯。不過,我們的研究結果和一般人口進行的研究一致,因此,NSAIDs的效果可能依據皮膚癌的基本風險。
  
  作者們使用丹麥癌症登記資料(DCR)確認1991-2009年、北丹麥區20歲以上者的全部SCC、MM和BCC案例;研究者確認了1,974例SCC、13,316例BCC和3242例MM。
  
  蒐集癌症網站資訊,排除已知有增加皮膚癌風險因素之疾病史(HIV、以前有癌症診斷、實體器官移植史)的病患。
  
  研究者使用丹麥公民註冊系統,根據年紀、性別和居住地為每個案例病患配對10名對照組,他們也使用該系統蒐集有關使用NSAID的資訊。確認類風濕性關節炎、偏頭痛、心血管疾病病史的病患,這些疾病被視為長期使用NSAID的代理指標。
  
  病患診斷SCC、BCC和MM時的年齡中位數為分別是77歲、67歲和57歲;診斷SCC者多數為男性(63%),腫瘤大多位於頭部和頸部(56%),診斷BCC者50%是男性,MM者有45%是男性。
  
  作者們聲明,分析較新的COX-2抑制劑受限於它們只有在某段研究期間內有,有時候還發生過下市。研究結果也可能因為DCR只有紀錄60%的SCC和BCC案例而造成偏見。此外,該研究依賴已調劑的處方進行分析,這可能無法反映實際使用的NSAID處方和自購成藥部分。不過,重複領用相同的藥物可能意味著遵守開立的治療處方。
  
  作者們指出,因為皮膚癌發生率高且NSAIDs使用廣泛,這些藥品的預防效果可能有重要的公衛影響。
  
  他們結論表示,他們觀察到包括阿斯匹靈在內的整體NSAIDs、其他非選擇性NSAIDs和較舊的COX-2抑制劑,與皮膚癌風險降低有關,特別是SCC和MM。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6835&x_classno=0&x_chkdelpoint=Y
  

Chronic Use of NSAIDs May Decrease the Risk for Skin Cancer

By Jennifer Garcia
Medscape Medical News

May 29, 2012 — Use of nonsteroidal anti-inflammatory drugs (NSAIDs) may decrease the risk for developing squamous cell carcinoma (SCC) or malignant melanoma (MM), according to a new population-based, case-control study published online May 29 in Cancer.

Use of NSAIDs overall (>2 prescriptions) was associated with a decreased risk for SCC (incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], 0.76 - 0.94) and MM (IRR, 0.87; 95% CI, 0.80 - 0.95) compared with nonuse (?2 prescriptions). This was especially true for long-term use (?7 years) and high-intensity use (>25% prescription coverage during the total duration of use). Although NSAID use was not associated with a reduced risk for basal cell carcinoma (BCC) overall (IRR, 0.97; 95% CI, 0.93 - 1.01), a reduced risk for BCC at sites other than the head was noted with long-term use (IRR, 0.85; 95% CI, 0.76 - 0.95) and high-intensity use (IRR, 0.79; 95% CI, 0.69 - 0.91).

"The effect [of NSAIDs] increased with greater duration and intensity of use, which may reflect a cumulative biologic effect (ie, a dose-response effect) exerted in the initiation of carcinogenesis," write Sigrun Alba Johannesdottir, BSc, from the Department of Clinical Epidemiology, Aarhus University Hospital, Denmark, and colleagues.

The researchers note that the NSAIDs associated with reduced risk were primarily nonselective NSAIDs and older cyclooxygenase (COX)-2 inhibitors (diclofenac, etodolac, and meloxicam). Unlike other studies, "[o]ur results do not support an association between newer COX-2 inhibitors and skin cancer or NSAIDs overall and BCC. However, our findings are in accordance with studies conducted in the general population. Thus, the effects of NSAIDs may depend on the baseline risk of skin cancer," the authors write.

Using the Danish Cancer Registry (DCR), the authors identified all cases of SCC, MM, and BCC diagnosed in individuals 20 years of age or older in northern Denmark from 1991 through 2009. The researchers identified 1974 diagnoses of SCC, 13,316 diagnoses of BCC, and 3242 diagnoses MM.

Information on the site of the cancer was collected, and patients with a history of disorders known to increase the risk for skin cancer (HIV, a previous cancer diagnosis, or history of solid organ transplantation) were excluded.

The investigators used the Danish Civil Registry System to match 10 population control individuals to each case patient based on age, sex, and country of residence. They also used the system to collect information regarding NSAID use. Patients with a history of rheumatoid arthritis, migraines, or cardiovascular disease were identified and these diseases used as proxy measures for chronic NSAID use.

The median age of patients at the time of diagnosis was 77 years, 67 years, and 57 years for SCC, BCC, and MM, respectively. Patients diagnosed with SCC were predominately men (63%), with tumors frequently located on the head and neck (56%). Men accounted for 50% of patients diagnosed with BCC and 45% of patients diagnosed with MM.

The authors acknowledge that analysis of newer COX-2 inhibitors was curtailed by the fact that they were only available during part of the study period and, in some instances, were withdrawn from the market. Results may also have been biased because only 60% of SCC and BCC cases are recorded in the DCR. In addition, the study relied on dispensed prescriptions, which may not accurately reflect actual drug use both among prescription and over-the-counter NSAID users. The authors note, however, that repeated refills for the same medications likely implies adherence to a prescribed treatment regime.

"Given the high skin cancer incidence and the widespread and frequent use of NSAIDs, a preventive effect of these agents may have important public health implications," the authors note.

"We observed that NSAIDs overall, including aspirin, other nonselective NSAIDs, and older COX-2 inhibitors, were associated with a decreased risk of skin cancer, particularly SCC and MM," they conclude.

Funding for this study was provided by the Clinical Epidemiological Research Foundation. The authors have disclosed no relevant financial relationships.

Cancer. Published online May 29, 2012.

    
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