Inhaled corticosteroids and risk of lung cancer among chronic obstructive pulmonary disease patients: a comprehensive analysis of nine prospective cohorts

Fan Ge; Yi Feng; Zhenyu Huo; Caichen Li; Runchen Wang; Yaokai Wen; Sirui Gao; Haoxin Peng; Xiangrong Wu; Hengrui Liang; Bo Cheng; Ran Zhong; Jianxing He; Wenhua Liang

doi:10.21037/tlcr-20-1126

Inhaled corticosteroids and risk of lung cancer among chronic obstructive pulmonary disease patients: a comprehensive analysis of nine prospective cohorts

Transl Lung Cancer Res. 2021 Mar;10(3):1266-1276. doi: 10.21037/tlcr-20-1126.

Authors

Fan Ge^{1

2}, Yi Feng^{1

3}, Zhenyu Huo^{1

3}, Caichen Li¹, Runchen Wang^{1

3}, Yaokai Wen^{1

3}, Sirui Gao^{1

3}, Haoxin Peng^{1

3}, Xiangrong Wu^{1

3}, Hengrui Liang¹, Bo Cheng¹, Ran Zhong¹, Jianxing He¹, Wenhua Liang¹

Affiliations

¹ Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² First Clinical School, Guangzhou Medical University, Guangzhou, China.
³ Nanshan School, Guangzhou Medical University, Guangzhou, China.

Abstract

Background: It remains uncertain whether there is a protective effect of inhaled corticosteroids (ICs) against lung cancer in chronic obstructive pulmonary disease (COPD) patients.

Methods: Databases including PubMed, Web of Science, EMBASE, and Medline were comprehensively searched. Random-effects model meta-analysis was conducted to calculate the hazard ratios (HRs) for lung cancer incidence among ICs users versus non-ICs users in patients with COPD. Stratified analysis was performed based on region and age of each study. This review was registered on PROSPERO (registration number CRD42020159082).

Results: Based on data from 181,859 COPD patients with a total follow-up duration of 1,109,339.9 person-years, we identified that the use of ICs in COPD patients was associated with a decreased risk of lung cancer [HR: 0.73, 95% confidence interval (CI): 0.62-0.86; P<0.001]. The region-specific HRs for lung cancer incidence were 0.62 (95% CI: 0.62-0.86; P=0.004), 0.77 (95% CI: 0.60-0.97; P=0.028) and 0.81 (95% CI: 0.61-1.08; P=0.155) among European, Asian and North American COPD patients, respectively. Additionally, we found the consistent outcome among age groups (≥70 years old: HR: 0.73, 95% CI: 0.65-0.99, P=0.043; <70 years old: HR: 0.74, 95% CI: 0.56-0.99, P=0.040).

Conclusions: This study demonstrates that ICs have a protective effect against lung cancer in COPD patients. It could provide guidance for clinicians in the prevention of lung cancer among patients with COPD.

Keywords: Inhaled corticosteroids; chronic obstructive pulmonary disease; lung cancer; meta-analysis.