Objective: To evaluate the extent to which cancer, a biological opposite to neurodegenerative disorders, may affect the onset and progression of Parkinson's disease (PD). Methods: A nested case-control design in consecutive PD patients with (cases) vs. without (controls) cancer was used to compare time to clinical diagnosis and time to Hoehn & Yahr (H&Y) staging score ≥ 3 as a measure of progression. Further, we compared PD onset and progression between cases with cancer diagnosis before (cancer before PD group) and after (cancer after PD group) PD onset. Independent variables were age at PD onset, motor subscale of the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, sex, cognitive impairment, falls, depression, anxiety, dementia, and autonomic symptoms. Time to H&Y ≥ 3 was determined using Cox proportional hazards, with adjusted results summarized as hazards ratio (HR). Group differences were evaluated using unpaired t-test or Fisher's exact test. Results: The clinical PD onset was later in cases vs. controls (median 67.2 vs. 59.8 years; p < 0.001), but the adjusted time to H&Y ≥ 3 was similar between groups (HR = 0.67; p = 0.13). Skin cancers constituted 75% of all cancers in cases. Amongst skin cancers, compared to controls, cases had an older age at PD onset (67.8 vs. 59.8 years; p < 0.001). There was no difference in risk of progression in PD patients with skin cancer compared to controls (HR = 0.54, p = 0.09). Conclusions: Cancer, in particular of the skin, may delay the onset but not the progression of PD. Future prospective observational studies are warranted to elucidate the complex interactions between these biologically divergent disorders.

中文翻译：

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皮肤癌可能会延缓帕金森氏病的发作，但不会延缓其进展：一项嵌套的病例对照研究。

目的：评估与神经退行性疾病相对的生物学癌症在多大程度上可能影响帕金森氏病（PD）的发作和进展。方法：采用连续病例患有（病例）vs。不患有（对照）癌症的PD患者的巢式病例对照设计，比较临床诊断时间和Hoehn＆Yahr（H＆Y）分期评分≥3的时间，以评估病情进展。此外，我们比较了在PD发作之前（PD组之前的癌症）和之后（PD组之后的癌症）进行癌症诊断的病例之间的PD发作和进展。自变量为PD发作时的年龄，运动障碍学会统一的帕金森氏病评分量表的运动亚量表，性别，认知障碍，跌倒，抑郁，焦虑，痴呆和自主神经症状。时间到H＆Y≥3是使用Cox比例风险确定的，调整后的结果总结为风险比率（HR）。使用未配对的t检验或Fisher精确检验评估组差异。结果：与对照组相比，患者的临床PD发作较晚（中位数为67.2 vs. 59.8岁； p <0.001），但两组之间H＆Y≥3的调整时间相似（HR = 0.67； p = 0.13）。皮肤癌占所有癌症病例的75％。在皮肤癌中，与对照组相比，PD发病年龄更大（67.8岁对59.8岁； p <0.001）。与对照组相比，PD皮肤癌患者的进展风险没有差异（HR = 0.54，p = 0.09）。结论：癌症，特别是皮肤癌，可能会延迟PD的发作，但不会延迟PD的进展。