The Nasopharyngeal Carcinoma and Its Effect on the Infectious Eye Disease: A Nationwide Cohort Study

Chia-Yi Lee; Ming-Ju Hsieh; Jing-Yang Huang; Yih-Shiou Hwang; Chao-Kai Chang; Hung-Chi Chen; Shun-Fa Yang

doi:10.3390/cancers14235745

The Nasopharyngeal Carcinoma and Its Effect on the Infectious Eye Disease: A Nationwide Cohort Study

Cancers (Basel). 2022 Nov 23;14(23):5745. doi: 10.3390/cancers14235745.

Authors

Chia-Yi Lee^{1

2

3}, Ming-Ju Hsieh^{4

5

6}, Jing-Yang Huang⁷, Yih-Shiou Hwang^{8

9}, Chao-Kai Chang^{2

10

11}, Hung-Chi Chen^{8

9

12}, Shun-Fa Yang^{1

7}

Affiliations

¹ Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan.
² Nobel Eye Institute, Taipei 100008, Taiwan.
³ Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 41265, Taiwan.
⁴ Oral Cancer Research Center, Changhua Christian Hospital, Changhua 50006, Taiwan.
⁵ Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan.
⁶ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan.
⁷ Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
⁸ Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan.
⁹ Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
¹⁰ Department of Optometry, Yuanpei University of Medical Technology, Hsinchu 30015, Taiwan.
¹¹ Department of Optometry, Da-Yeh University, Chunghua 51500, Taiwan.
¹² Center for Tissue Engineering, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan.

Abstract

The purpose of this study is to investigate the potential correlation between nasopharyngeal carcinoma (NPC) and both infectious keratitis and orbital cellulitis. The retrospective cohort study used the National Health Insurance Research Database (NHIRD) as a data source. A total number of 4184 patients with NPC diagnosis were selected and matched to 16,736 non-NPC patients via the propensity-score matching (PSM). The main outcomes are the development of infectious keratitis and orbital cellulitis according to diagnostic codes and related medications. The Cox proportional hazard regression was adopted to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of outcomes between the two groups. A total of 35 and 19 episodes of orbital cellulitis occurred in the NPC and non-NPC groups and the aHR was significantly higher in the NPC group (aHR: 1.34, 95% CI: 1.23−1.46, p = 0.0024). There were 2185 and 659 events of infectious keratitis in the NPC and non-NPC groups, and the NPC group revealed a significantly higher aHR than non-NPC group (aHR: 1.34, 95% CI: 1.23−1.46, p < 0.0001). Besides, the cumulative probability of infectious keratitis was significantly higher in the NPC group than the non-NPC group (p < 0.0001). The other risk factors of infectious keratitis include age from 20 to 30 years old, allergic respiratory diseases, allergic dermatological diseases, and external eye diseases (all p < 0.0001). In subgroup analyses, both the incidences of infectious keratitis (aHR: 1.33, 95% CI: 1.21−1.47) and orbital cellulitis (aHR: 2.36, 95% CI: 1.27−4.39) were significantly higher than the non-NPC group. The incidence of infectious keratitis was significantly higher in NPC patients without radiotherapy (aHR: 1.40, 95% CI: 1.26−1.55) compared to non-NPC population, while the rate of orbital cellulitis was similar between the NPC patients without radiotherapy (aHR: 0.76, 95% CI: 0.27−2.14) and non-NPC population. In conclusion, the existence of NPC associates with higher incidence of infectious keratitis which increases with NPC period, and the radiotherapy may be account for the higher rate of orbital cellulitis in NPC population.

Keywords: epidemiology; infection; infectious keratitis; nasopharyngeal carcinoma; orbital cellulitis.

Grants and funding

This research received no external funding.