Department of Surgery, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Int J Gynecol Cancer. 2013 Jan;23(1):16-24. doi: 10.1097/IGC.0b013e318277608b.
We aimed to examine the association between in vitro fertilization (IVF) and risk of cancers through conducting a meta-analysis of cohort studies.
Relevant studies were identified by using PubMed, ISI Web of knowledge, and Scopus through March 2012. Reference lists from retrieved articles were also reviewed. We included historical cohort studies that reported relative risks (RRs) with 95% confidence intervals (CIs) for the association between IVF and cancer risk. Both fixed- and random-effects models were used to calculate the summary risk estimates.
Eight cohort studies involving 746,455 participants were included in this meta-analysis. The overall combined RRs for women with IVF treatment were 0.99 (95% CI, 0.74-1.32) for all-site cancer, 1.59 (95% CI, 1.24-2.03) for ovarian cancer, 0.89 (95% CI, 0.79-1.01) for breast cancer, and 1.07 (95% CI, 0.45-2.55) for cervical cancer. A beneficial effect was shown in the subgroup of breast cancer meta-analysis compared with women who gave birth (RR, 0.79; 95% CI, 0.65-0.95). Excess risk of ovarian cancer was still observed when analyses were restricted to studies with less than 8 years of follow-up (RR, 2.35; 95% CI, 1.03-5.37) and studies including cancer cases diagnosed within 1 year of the IVF treatment (RR, 1.71; 95% CI, 1.22-2.40). No evidence of substantial publication bias was observed.
This meta-analysis suggests that there is no significant association between IVF and cancer risk. A possible beneficial effect was shown in the subgroup of breast cancer meta-analysis. Excess risk of ovarian cancer was observed in the analysis of all the studies and subgroups. Special attention should be made to women who may be diagnosed with cancer during or shortly after IVF treatment. Studies of high methodological quality with larger population and longer follow-up are required to provide more evidences for a better understanding of the association.
通过对队列研究进行荟萃分析，研究体外受精（IVF）与癌症风险之间的关系。
通过 2012 年 3 月前的 PubMed、ISI Web of knowledge 和 Scopus 检索相关研究，并对检索文章的参考文献进行综述。我们纳入了报道 IVF 与癌症风险之间关联的相对风险（RR）和 95%置信区间（CI）的历史性队列研究。采用固定效应模型和随机效应模型计算汇总风险估计值。
共有 8 项队列研究纳入了 746455 名参与者。接受 IVF 治疗的女性发生所有部位癌症的总体合并 RR 为 0.99（95%CI，0.74-1.32），卵巢癌为 1.59（95%CI，1.24-2.03），乳腺癌为 0.89（95%CI，0.79-1.01），宫颈癌为 1.07（95%CI，0.45-2.55）。与自然分娩的女性相比，乳腺癌亚组分析显示出有益的效果（RR，0.79；95%CI，0.65-0.95）。当将分析仅限于随访时间少于 8 年的研究（RR，2.35；95%CI，1.03-5.37）和包括 IVF 治疗后 1 年内诊断出的癌症病例的研究（RR，1.71；95%CI，1.22-2.40）时，仍观察到卵巢癌的风险增加。未发现明显的发表偏倚。
本荟萃分析表明，IVF 与癌症风险之间无显著关联。在乳腺癌亚组分析中观察到可能存在有益的效果。在所有研究和亚组分析中均观察到卵巢癌风险增加。应特别关注在 IVF 治疗期间或治疗后不久可能被诊断为癌症的女性。需要进行方法学质量更高、人群更大、随访时间更长的研究，以提供更多证据，从而更好地了解这种关联。
