چکیده :
BACKGROUND: Endocarditis may be a marker for bacteremia-associated occult cancer. Intensive antibiotic
treatment in endocarditis is suggested to reduce long-term cancer risk. We examined these hypotheses in
a nationwide cohort study.
METHODS: Endocarditis patients and cancer cases were identified from the Danish National Registry of
Patients and the Danish Cancer Registry during 1978-2008. We compared the incidences of various
cancers among study subjects to expected incidences based on national age-, sex-, and site-specific rates.
RESULTS: We observed 997 cancers among 8445 endocarditis patients (median follow-up of 3.5 years),
reflecting an increased standardized incidence rate (SIR) of 1.61 (95% confidence interval [CI], 1.51-1.71).
Cancer risk was highly elevated during the first 3 months of follow-up (SIR8.03; 95% CI, 6.92-9.26),
partly due to a 15- to 30-fold increased risk of hematological or liver cancers. Between 3-month and 5-year
follow-ups, cancer incidence remained 1.5-fold higher than expected, including 2- and 4-fold increased
SIRs for colorectal and liver cancers, respectively. Beyond 5 years of observation, the overall cancer SIR
was 1.21 (95% CI, 1.10-1.34). Long-term associations were weak for several cancers hypothesized to be
associated with antibiotic use, including prostate, gastric, and breast cancer.
CONCLUSION: Endocarditis is a substantial clinical marker for presence of occult cancer. We found no
evidence of decreased long-term cancer risk after antibiotic treatment for endocarditis.
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