Department of Public Health Sciences, University of Alberta, Edmonton, Alta.
CMAJ. 2012 Sep 4;184(12):E675-83. doi: 10.1503/cmaj.112102. Epub 2012 Jul 3.
Patients with type 2 diabetes have a 40% increased risk of bladder cancer. Thiazolidinediones, especially pioglitazone, may increase the risk. We conducted a systematic review and meta-analysis to evaluate the risk of bladder cancer among adults with type 2 diabetes taking thiazolidinediones.
We searched key biomedical databases (including MEDLINE, Embase and Scopus) and sources of grey literature from inception through March 2012 for published and unpublished studies, without language restrictions. We included randomized controlled trials (RCTs), cohort studies and case-control studies that reported incident bladder cancer among people with type 2 diabetes who ever (v. never) were exposed to pioglitazone (main outcome), rosiglitazone or any thiazolidinedione.
Of the 1787 studies identified, we selected 4 RCTs, 5 cohort studies and 1 case-control study. The total number of patients was 2,657,365, of whom 3643 had newly diagnosed bladder cancer, for an overall incidence of 53.1 per 100,000 person-years. The one RCT that reported on pioglitazone use found no significant association with bladder cancer (risk ratio [RR] 2.36, 95% confidence interval [CI] 0.91-6.13). The cohort studies of thiazolidinediones (pooled RR 1.15, 95% CI 1.04-1.26; I(2) = 0%) and of pioglitazone specifically (pooled RR 1.22, 95% CI 1.07-1.39; I(2) = 0%) showed significant associations with bladder cancer. No significant association with bladder cancer was observed in the two RCTs that evaluated rosiglitazone use (pooled RR 0.87, 95% CI 0.34-2.23; I(2) = 0%).
The limited evidence available supports the hypothesis that thiazolidinediones, particularly pioglitazone, are associated with an increased risk of bladder cancer among adults with type 2 diabetes.
2 型糖尿病患者膀胱癌风险增加 40%。噻唑烷二酮类药物，尤其是吡格列酮，可能会增加这种风险。我们进行了一项系统回顾和荟萃分析，以评估 2 型糖尿病患者使用噻唑烷二酮类药物的膀胱癌风险。
我们检索了主要的生物医学数据库（包括 MEDLINE、Embase 和 Scopus）和灰色文献来源，检索时间从建库到 2012 年 3 月，以获取关于 2 型糖尿病患者使用吡格列酮（主要结局）、罗格列酮或任何噻唑烷二酮类药物的已发表和未发表的研究，不限制语言。我们纳入了报告 2 型糖尿病患者中曾（v. 从未）使用过吡格列酮、罗格列酮或任何噻唑烷二酮类药物的患者中出现膀胱癌的随机对照试验（RCT）、队列研究和病例对照研究。
在 1787 项研究中，我们选择了 4 项 RCT、5 项队列研究和 1 项病例对照研究。总患者数为 2657365 人，其中 3643 人新诊断为膀胱癌，总发病率为 53.1/100000 人年。唯一一项报告吡格列酮使用情况的 RCT 未发现膀胱癌与吡格列酮之间存在显著关联（风险比[RR]2.36，95%置信区间[CI]0.91-6.13）。噻唑烷二酮类药物（汇总 RR 1.15，95%CI1.04-1.26；I(2)=0%）和吡格列酮（汇总 RR 1.22，95%CI1.07-1.39；I(2)=0%）的队列研究均显示与膀胱癌存在显著关联。两项评估罗格列酮使用情况的 RCT（汇总 RR 0.87，95%CI0.34-2.23；I(2)=0%）均未观察到膀胱癌与罗格列酮之间存在显著关联。
现有有限的证据支持噻唑烷二酮类药物，尤其是吡格列酮，与 2 型糖尿病患者膀胱癌风险增加相关的假设。
