The Investigation between Voiding Function Medication and the Risk of Bladder Cancer in Patients with Spinal Cord Injury

探究影響膀胱功能的藥物與脊髓損傷病患罹患膀胱腫瘤的風險

10.6315/TJPMR.202106_49(1).0008

陳凱華(Kai-Hua Chen)；王鼎堯(Ting-Yao Wang)；陳建旻(Chien-Min Chen)；李全濱(Chuan-Pin Lee)；楊曜旭(Yao-Hsu Yang)；林衢序(Chu-Hsu Lin)；龔冠毓(Kuan-Yu Kung)；陳錦宏(Vincent Chin-Hung Chen)

bladder cancer ； medication ； risk factor ； spinal cord injury ； 膀胱癌（bladder cancer） ； 藥物（medication） ； 危險因子（risk factor） ； 脊髓損傷（spinal cord injury）

台灣復健醫學雜誌

49卷1期（2021 / 06 / 01）

91 - 104

英文

Bladder cancer (BC) is a chronic complication of spinal cord injury (SCI). Limited studies have focused on the risks of BC in SCI patients using voiding function medication for bladder dysfunction. In this retrospective, national-wide, population-based cohort study, SCI patients with registration in the National Health Insurance Research Database (NHIRD) from 1998 to 2013 were included. We investigated the risk of BC in SCI patients administered voiding function medications and other comorbidities by 2-year landmark analysis. SCI patients were divided into medication user (bethanechol, oxybutynin, or tolterodine) and non-medication user groups at landmark period. They were followed until the development of BC, death, or any other reason for loss to follow-up. Cox regression models and competing risk regression were used to investigate BC risks. In our study, 47,373 SCI patients registered in our database met the inclusion criteria. After exclusion, 22,974 patients were divided into medication user and non-medication user groups. There were no increased BC risks in medication user group, comparing to non-medication user group, neither in different cDDD nor subgroup analyses. In the subgroup analysis of medication user group, age more than 45 years (aHR: 1.93-2.45), male (aHR: 1.62), higher economic levels (aHR: 1.82), renal stone (aHR: 2.43), and chronic urinary tract infection (aHR: 2.18) were independent factors increased BC. Voiding dysfunction medication did not increase the risk of BC in SCI. Physician should still pay attend on other risk factors of BC in SCI patients.

膀胱癌是脊髓損傷患者的慢性併發症。過往文獻甚少探討治療膀胱功能異常的排尿功能藥物對脊髓損傷患者罹患膀胱癌的風險。在本篇回溯性全國性世代研究中，以健保資料庫中已登錄罹患脊髓損傷患者為納入條件，採用標誌性分析（landmark analysis）探討使用排尿功能藥物及合併其他共病時脊髓損傷患者發生膀胱癌的風險。患者分為藥物使用組和非藥物使用組，並以Cox回歸模型（Cox regression analysis）和競爭風險回歸（competing risk regression）分析膀胱癌的風險。本研究共計22,974名患者進入標誌性分析，研究發現藥物使用組和非藥物使用組之間在膀胱癌風險沒有統計學上的顯著差異。在藥物使用組的亞組分析中，發現以下幾個獨立因子增加罹患膀胱癌的風險，包括年齡大於45歲、男性、較高的經濟水平、腎結石病史和慢性尿道感染。本研究結論是排尿功能藥物並不會增加脊髓損傷患者的膀胱癌風險，醫師仍應注意患者是否具有前述膀胱癌的危險因子。

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