Long-term glucocorticoid (GC) exposure causes immunosuppression; therefore, the risk of cancer may be increased in long-term GC users. We investigated whether long-term GC use is associated with a higher risk of cancer in the population without cancer. A population-based cohort study using data from the National Health Insurance Service was conducted among the South Korean adult population in 2010. Long-term GC users were defined as those who were prescribed a continuous supply of oral GC for ≥30 days. The primary endpoint was a new cancer diagnosis from January 1, 2011, to December 31, 2015. Among 770,880 individuals included in the analysis, 1,602 (0.2%) were long-term GC users and 36,157 (4.7%) were newly diagnosed with cancer from January 2011 to December 2015. In the multivariable Cox regression analysis, the risk of cancer among long-term GC users was 1.23-fold higher than that of the unexposed individuals [95% confidence interval (CI), 1.06–1.43; P = 0.007]. In the competing risk analyses, the risks of liver cancer and lung cancer were 1.46-fold (95% CI, 1.03–2.07; P = 0.034) and 1.52-fold (95% CI, 1.04–2.21; P = 0.029) higher in the long-term GC users than that of the unexposed individuals, respectively. We found that long-term GC exposure might be associated with a higher risk of overall cancer, and this association was more evident for lung and liver cancer risk. However, because there might be unmeasured and potential confounders in this study, the results should be interpreted carefully, and future studies should be performed to confirm these findings. Impact: Long-term glucocorticoid therapy might be associated with a higher cancer risk. This association was more evident for lung and liver cancer risk. Our findings suggest that long-term prescriptions of glucocorticoids should be administered carefully considering the risk of cancer.

中文翻译：

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长期使用糖皮质激素和癌症风险：韩国一项基于人群的队列研究

长期接触糖皮质激素 (GC) 会导致免疫抑制；因此，长期使用 GC 的人患癌症的风险可能会增加。我们调查了长期使用 GC 是否与未患癌症的人群患癌症的风险较高有关。2010 年，一项使用国民健康保险服务数据的基于人群的队列研究在韩国成年人群中进行。长期 GC 用户被定义为那些被规定连续 30 天以上口服 GC 的人。主要终点是 2011 年 1 月 1 日至 2015 年 12 月 31 日的新癌症诊断。在纳入分析的 770,880 名个体中，1,602 (0.2%) 名长期使用 GC 用户，36,157 (4.7%) 名新诊断为癌症从 2011 年 1 月到 2015 年 12 月。在多变量 Cox 回归分析中，长期 GC 使用者患癌症的风险比未接触者高 1.23 倍 [95% 置信区间 (CI)，1.06–1.43；P = 0.007]。在竞争风险分析中，肝癌和肺癌的风险分别高出 1.46 倍（95% CI，1.03–2.07；P = 0.034）和 1.52 倍（95% CI，1.04–2.21；P = 0.029）长期 GC 用户的比例分别高于未暴露的个人。我们发现长期接触 GC 可能与总体癌症风险较高有关，这种关联对于肺癌和肝癌风险更为明显。然而，由于本研究中可能存在未测量的和潜在的混杂因素，因此应对结果进行仔细解释，并应进行未来的研究以证实这些发现。影响：长期糖皮质激素治疗可能与较高的癌症风险有关。这种关联对于肺癌和肝癌风险更为明显。我们的研究结果表明，考虑到癌症的风险，应谨慎使用长期的糖皮质激素处方。