Onega Tracy, Baron John, MacKenzie Todd
Department of Medicine, Dartmouth Medical School, Evergreen Center, Suite 300, 46 Centerra Parkway, Lebanon, NH 03756, USA.
Cancer Epidemiol Biomarkers Prev. 2006 Aug;15(8):1532-7. doi: 10.1158/1055-9965.EPI-06-0127.
Some epidemiologic and laboratory studies have suggested that total joint arthroplasty could increase the risk of cancer. In this meta-analysis, we attempt to clarify the association of joint arthroplasty with subsequent cancer incidence.
We identified population-based studies reporting standardized incidence ratios (SIR) for cancer following large joint arthroplasty. After summing the observed and expected numbers of cases across all qualifying studies, we calculated SIRs for all cancers, and for those at 28 anatomic sites. Latency analysis involving 175,166 patients characterized short-term and long-term cancer associations.
The analyses included 1,435,356 person-years of follow-up and 20,045 cases of cancer. Overall cancer risk among patients with arthroplasty was equal to that for the general population. The relative risk of lung cancer, reduced in the first 5 years after arthroplasty, increased significantly over time to approach that of the general population. Risks for all sites in the luminal gastrointestinal tract were significantly reduced by 10% to 20%; with relative risks that were generally stable over time. Increased risks were seen for cancer of the prostate (SIR, 1.12; 95% confidence interval, 1.08-1.16); similar relative risks were seen in each time period after the procedure. For melanoma, relative risks increased with follow-up to a SIR of 1.43 (95% confidence interval, 1.13-1.79) for 10 or more years after arthroplasty. There was a similar delayed emergence of increased risks for cancers of the urinary tract and oropharynx. The relative risk for bone cancer decreased with time after the procedure.
There does not seem to be an overall increased risk of cancer following total joint arthroplasty. Although the risks of prostate cancer and melanoma seem to be elevated, there is no obvious mechanism for these associations. Reductions in risk for some malignancies may not be causal.
一些流行病学和实验室研究表明，全关节置换术可能会增加患癌风险。在这项荟萃分析中，我们试图阐明关节置换术与后续癌症发病率之间的关联。
我们确定了基于人群的研究，这些研究报告了大关节置换术后癌症的标准化发病率（SIR）。在汇总所有符合条件研究中的观察病例数和预期病例数后，我们计算了所有癌症以及28个解剖部位癌症的SIR。对175,166名患者进行的潜伏期分析确定了短期和长期癌症关联。
分析包括1,435,356人年的随访和20,045例癌症病例。关节置换术患者的总体癌症风险与一般人群相当。肺癌的相对风险在关节置换术后的前5年降低，随着时间的推移显著增加，接近一般人群。腔内胃肠道所有部位的风险显著降低10%至20%；相对风险随时间总体稳定。前列腺癌风险增加（SIR，1.12；95%置信区间，1.08 - 1.16）；术后各时间段的相对风险相似。对于黑色素瘤，随着随访时间延长，关节置换术后10年或更长时间的相对风险增加至SIR为1.43（95%置信区间，1.13 - 1.79）。尿路和口咽癌的风险增加也有类似的延迟出现。骨癌的相对风险在术后随时间降低。
全关节置换术后似乎不存在总体患癌风险增加的情况。虽然前列腺癌和黑色素瘤的风险似乎有所升高，但这些关联没有明显的机制。某些恶性肿瘤风险的降低可能并非因果关系。
