雙磷酸鹽類與食道癌:看似無關


  【24drs.com】根據發表於美國胃腸科學院(ACG)2012年科學會議暨畢業後訓練課程的一篇研究,雙磷酸鹽類(BPs)與食道癌風險增加無關。
  
  口服雙磷酸鹽類藥物一般用來預防和治療骨質疏鬆症,但若此類製劑滯留在食道時,可能會導致糜爛性食道炎;之前某些研究認為,長期使用雙磷酸鹽類藥物和食道癌風險增加有關,不過研究結果各有衝突。
  
  佛羅里達Jacksonville梅約診所胃腸科研究員、發表此篇研究的Saowanee Ngamruengphong醫師表示,有些人擔心食道炎可能會引起發炎和致癌。
  
  研究者對控制型觀察研究進行了系統性回顧與統合分析,搜尋1950-2012年的MEDLINE資料庫,檢視檢索文章的參考文獻,包括了使用雙磷酸鹽類藥物組與對照組之食道癌結果的所有控制型觀察研究。
  
  從校正的效益估計與標準誤,使用隨機效益模式計算彙整之勝算比(ORs)與95%信心區間(CIs);使用Cochrane Q X2檢測確認這些效益的異質性。
  
  檢視的42篇研究中,6篇研究(3篇世代研究、3篇案例控制研究)共3,570名食道癌病患被納入分析,其中5篇研究是在西方國家進行;相較於未使用雙磷酸鹽類藥物者,使用雙磷酸鹽類藥物者的彙整OR值為1.02 (95% CI,0.73 - 1.42);各研究之間並未發現顯著的異質性(P = .15)。
  
  研究者也進行了敏感性分析,發現案例控制研究的彙整OR值略呈顯著(OR,1.28;95% CI,1.01 - 1.63)。
  
  Ngamruengphong醫師表示,我們並未發現雙磷酸鹽類製劑有任何引起食道癌的風險;如果病患確實需要使用雙磷酸鹽類製劑治療骨科疾病,無須因為擔憂食道癌而停用。
  
  明尼蘇達州羅徹斯特梅約診所食道專家、未參與此研究的Yvonne Romero醫師表示,這些研究結果有其意義,服用阿斯匹靈的女士們只用少量水去吞服,卻不知道自己吞藥時的風險;如果藥丸順利到達胃部,那很好,如果它卡在食道,會造成灼傷與引起藥物性食道炎。這類藥物包括了阿斯匹靈、ibuprofen、鐵質補充劑與雙磷酸鹽類。
  
  認為藥物性食道炎和食道癌有關的某些研究,實際上可能是服用雙磷酸鹽類藥物的病患因為藥物性食道炎的劇痛而急診,一到急診室,醫師會進行診察,如果病患有食道癌,就會被發現。Romero醫師表示,這並非雙磷酸鹽類製劑致癌—只是因而引起醫師的注意,也正是此次統合分析所顯示的結果。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6954&x_classno=0&x_chkdelpoint=Y
  

Bisphosphonates and Esophageal Cancer: No Link Seen

By Jim Kling
Medscape Medical News

LAS VEGAS, Nevada — Bisphosphonates (BPs) are not associated with an increased risk for esophageal cancer, according to a study presented here at the American College of Gastroenterology (ACG) 2012 Annual Scientific Meeting and Postgraduate Course.

Oral BPs are commonly used to prevent and treat osteoporosis, but they can cause erosive esophagitis when pills become entrapped in the esophagus. Some previous studies had suggested an association between long-term BP use and an increased risk for esophageal cancer, but there were conflicting results.

"Some people are concerned that esophagitis might cause inflammation and lead to (cancer)," presenter Saowanee Ngamruengphong, MD, a gastrointestinal fellow at the Mayo Clinic in Jacksonville, Florida, told Medscape Medical News.

The researchers performed a systematic review and meta-analysis of controlled observational studies. MEDLINE was searched from 1950 to 2012, and bibliographies of all retrieved articles were examined. They included all controlled observational studies that compared esophageal cancer outcome in patients using BPs with control groups.

A random effects model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs) from adjusted effect estimates with standard error. Heterogeneity of the effects was determined using the Cochrane Q X2 test.

Of the 42 studies identified, 6 studies (3 cohort, 3 case-controlled) with 3570 esophageal cancer patients were selected for analysis. Five of the studies were conducted in western countries. The pooled OR for BP users, compared with nonusers, was 1.02 (95% CI, 0.73 - 1.42). No significant heterogeneity between studies was found (P = .15).

The researchers also conducted a sensitivity analysis and found that the pooled OR of the case-controlled studies was marginally significant (OR, 1.28; 95% CI, 1.01 - 1.63).

"We don't see any risk of bisphosphonate-induced esophageal cancer. If patients really need to be on bisphosphonates for bone disease, you should not stop it based on fear of esophageal cancer," said Dr. Ngamruengphong.

"(The finding) makes sense to me," Yvonne Romero, MD, an esophagologist at Mayo Clinic in Rochester, Minnesota, who was not involved in the study, told Medscape Medical News. "I see these little old ladies who want to take aspirin with just enough water to get it down. They don't realize they're taking a risk. If the pill makes it to the stomach, fabulous. But if it stays in the esophagus, it will burn and cause pill esophagitis. Drugs that do that include aspirin, ibuprofen, iron supplements, and bisphosphonates."

It is likely that studies suggesting an association between pill esophagitis and esophageal cancer were really showing that patients taking BPs were occasionally going to the emergency department for pill esophagitis, which is often quite painful. Once there, patients would be examined by physicians, and if they had esophageal cancer, it would be discovered. "It wasn't that bisphosphonates caused the cancer — they just brought it to (the physician's) attention. That's what this meta-analysis shows," said Dr. Romero.

Dr. Ngamruengphong and Dr. Romero have disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2012 Annual Scientific Meeting and Postgraduate Course: Abstract P577. Presented October 22, 2012.

    
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