Gastroesophageal reflux disease (GERD) might be associated with a higher risk for non–small cell lung cancer (NSCLC) development, according to data from a retrospective case-control study presented at the 2020 American College of Gastroenterology (ACG) Annual Scientific Meeting.
The investigators used patient data collected from 17 Northwell Health care facilities in the New York Area between 2010 and 2018. Adults who received a NSCLC diagnosis (large cell, adenocarcinoma, or squamous cell carcinoma) based on ICD-9/10 codes were included. To qualify, patients must have received a GERD diagnosis prior to presenting with NSCLC.
GERD diagnoses were based on ICD-9/10 codes, endoscopic, and/or histologic evidence. Individuals with GERD and NSCLC were matched with controls based on age, gender, weight, comorbidities, and medication use. Patients with secondary lung cancers, esophageal adenocarcinoma, Barrett esophagus, a primary malignancy other than NSCLC, or a history of smoking were excluded.
Group A comprised 543 patients with GERD and NSCLC; group B included 540 control patients who had GERD, but not NSCLC. The median age was comparable in both groups (A, 72.9±13.1 vs B, 71.7±10.7; P =.091). GERD was found to be twice as prevalent in group A (20.4% vs 11.6%; P <.001).
In a multivariate analysis, GERD was associated with a risk for subsequent NSCLC development that was higher in group A than it was in group B (adjusted odds ratio [OR], 1.86; 95% CI, 1.26-2.73; P <.01). “We postulate that [patients with] GERD may suffer from chronic micro-aspirations, leading to a prolonged inflammatory state within the lung parenchyma triggering proliferative signaling pathways leading to malignant transformation,” the study authors said.
Findings from the same multivariate analysis also indicated that patients with GERD who received antihistamines or proton pump inhibitor therapy did not have a reduced risk for NSCLC (adjusted OR, 1.01; 95% CI, 0.48-2.12), signifying that GERD “might be associated with a higher risk for NSCLC, irrespective of the treatment [for] GERD,” the investigators added.
Excluding GERD, asthma (adjusted OR, 2.07; 95% CI, 1.03-4.16; P =.04), opioid use (adjusted OR, 1.82; 95% CI, 1.12-2.95; P =.01), and prednisone (adjusted OR, 1.75; 95% CI, 0.99-3.08; P =.05) were the 3 most significant risk factors for NSCLC development. Although the findings point to a possible clinical connection between GERD and subsequent NSCLC, the study authors concluded that future prospective trials are ultimately necessary to “explore this relationship and clarify the role of GERD therapy” relative to NSCLC risk.
Amarnath S, Starr A, Abureesh M, et al. The association between gastroesophageal reflux disease and non–small cell lung cancer: a retrospective case control study. Poster presented at: American College of Gastroenterology Annual Scientific Meeting; October 26-28, 2020. P0872.