Huncharek Michael, Geschwind J F, Kupelnick Bruce
Department of Clinical Oncology, Marshfield Clinic Cancer Center, Marshfield, WI, USA.
Anticancer Res. 2003 Mar-Apr;23(2C):1955-60.
Prior epidemiological studies suggest an association between perineal cosmetic talc use and increased risk of epithelial ovarian cancer. A meta-analysis was performed to evaluate this suspected association.
Using previously described methods, a protocol was developed for a meta-analysis examining the association between perineal talc use versus non-use and the development of invasive epithelial ovarian cancer. Literature search techniques, study inclusion criteria and statistical procedures were prospectively defined. Data from observational studies were pooled using a general variance based meta-analytic method employing confidence intervals previously described by Greenland. The outcome of interest was a summary relative risk (RRs) reflecting the risk of ovarian cancer development associated with perineal talc use versus non-use. Sensitivity analyses were performed when necessary to explain any observed statistical heterogeneity.
Sixteen observational studies meeting protocol specified inclusion criteria were located via a comprehensive literature search. These studies enrolled a total of 11,933 subjects. Analysis for heterogeneity demonstrated that the data were homogenous (p = 0.17) and could be combined in a meta-analysis. Pooling all sixteen studies yielded a RRs of 1.33 (CI = 1.16-1.45), a statistically significant result suggesting a 33% increased risk of ovarian cancer with perineal talc use. Despite this finding, the data showed a lack of a clear dose-response relationship making the RRs of questionable validity. Further sensitivity analyses showed that hospital-based studies showed no relationship between talc use and ovarian cancer risk, i.e. RRs 1.19 (0.99-1.41) versus population-based studies (RRs = 1.38, CI = 1.25-1.52). This suggests that selection bias and/or uncontrolled confouding may result in a spurious positive association between talc use and ovarian cancer risk in population-based studies.
The available observational data do not support the existence of a causal relationship between perineal talc exposure and an increased risk of epithelial ovarian cancer. Selection bias and uncontrolled confouding may account for the positive associations seen in prior epidemiological studies.
先前的流行病学研究表明，会阴部使用滑石粉进行美容与上皮性卵巢癌风险增加之间存在关联。进行了一项荟萃分析以评估这种疑似关联。
使用先前描述的方法，制定了一项荟萃分析方案，以研究会阴部使用滑石粉与不使用滑石粉和侵袭性上皮性卵巢癌发生之间的关联。前瞻性地定义了文献检索技术、研究纳入标准和统计程序。使用基于一般方差的荟萃分析方法汇总观察性研究的数据，该方法采用格陵兰先前描述的置信区间。感兴趣的结果是汇总相对风险（RRs），反映与会阴部使用滑石粉与不使用滑石粉相关的卵巢癌发生风险。必要时进行敏感性分析以解释任何观察到的统计异质性。
通过全面的文献检索找到了16项符合方案指定纳入标准的观察性研究。这些研究共纳入了11,933名受试者。异质性分析表明数据是同质的（p = 0.17），可以在荟萃分析中进行合并。汇总所有16项研究得出RRs为1.33（CI = 1.16 - 1.45），这是一个具有统计学意义的结果，表明会阴部使用滑石粉会使卵巢癌风险增加33%。尽管有这一发现，但数据显示缺乏明确的剂量反应关系，使得RRs的有效性存疑。进一步的敏感性分析表明，基于医院的研究显示滑石粉使用与卵巢癌风险之间没有关系，即RRs为1.19（0.99 - 1.41），而基于人群的研究（RRs = 1.38，CI = 1.25 - 1.52）。这表明在基于人群的研究中，选择偏倚和/或未控制的混杂因素可能导致滑石粉使用与卵巢癌风险之间出现虚假的正相关。
现有的观察性数据不支持会阴部接触滑石粉与上皮性卵巢癌风险增加之间存在因果关系。选择偏倚和未控制的混杂因素可能是先前流行病学研究中所见正相关的原因。
