糖尿病作为肺癌的独立危险因素：一项观察性研究的荟萃分析。

Diabetes mellitus as an independent risk factor for lung cancer: a meta-analysis of observational studies.

机构信息

Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, Republic of Korea.

出版信息

Eur J Cancer. 2013 Jul;49(10):2411-23. doi: 10.1016/j.ejca.2013.02.025. Epub 2013 Apr 3.

DOI:10.1016/j.ejca.2013.02.025

PMID:23562551

Abstract

BACKGROUND

Epidemiologic studies have demonstrated inconsistent associations between diabetes mellitus and the risk of lung cancer. To determine whether diabetes mellitus is associated with an increased risk of lung cancer, we performed a meta-analysis of observational studies.

METHODS

PubMed, EMBASE and the Cochrane Library were searched for observational studies conducted prior to September 2012. We included prospective cohort studies that reported relative risks and case-control studies that showed odds ratios in the analysis. The pooled relative risk (RR) with 95% confidence intervals (CIs) was calculated with a random effects model. Sensitivity analysis was performed with studies which controlled for smoking status. Associations were assessed in several subgroups representing different participant and study characteristics.

RESULTS

A total of 34 studies from 24 manuscripts (10 case-control studies and 24 cohort studies) were included in the analyses. Diabetes was significantly associated with the increased risk of lung cancer compared with non-diabetic controls when limiting the analysis to studies adjusting for smoking status (RR, 1.11; 95% CI, 1.02-1.20; I(2)=46.1%). By contrast, this association disappeared when the analysis was restricted to studies not adjusting for smoking status (RR, 0.99; 95% CI, 0.88-1.11; I(2)=96.7%). When stratifying by sex, an increased risk of lung cancer was prominent in diabetic women (RR, 1.14; 95% CI, 1.09-1.20; I(2)=0%), while there was no association in diabetic men (RR, 1.07; 95% CI, 0.89-1.28; I(2)=96.6%). Among diabetic women, significantly increased risks of lung cancer were found in the following subgroups: cohort studies (RR, 1.14; 95% CI, 1.08-1.20; I(2)=0%), studies controlling for major confounding variables such as age, smoking and alcohol (RR, 1.19; 95% CI, 1.00-1.43; I(2)=23.1%), studies with long-term follow-up (RR, 1.14; 95% CI, 1.08-1.20; I(2)=0%), and high-quality studies assessed by the Newcastle-Ottawa Scale (RR, 1.14; 95% CI, 1.08-1.20; I(2)=0%).

INTERPRETATION

Preexisting diabetes mellitus may increase the risk of lung cancer, especially among female diabetic patients. Further large-scale prospective studies are needed to test specifically the effect of diabetes mellitus on lung cancer risk.

摘要

背景

流行病学研究表明，糖尿病与肺癌风险之间的关联并不一致。为了确定糖尿病是否与肺癌风险增加有关，我们对观察性研究进行了荟萃分析。

方法

检索了截至 2012 年 9 月之前发表的观察性研究的 PubMed、EMBASE 和 Cochrane 图书馆。我们纳入了报告相对风险的前瞻性队列研究和显示病例对照研究比值比的病例对照研究。使用随机效应模型计算合并的相对风险（RR）及其 95%置信区间（CI）。我们对控制吸烟状况的研究进行了敏感性分析。根据不同的参与者和研究特征，评估了各种亚组之间的关联。

结果

共有 24 篇论文中的 34 项研究（10 项病例对照研究和 24 项队列研究）纳入了分析。与非糖尿病对照组相比，当限制分析仅限于调整吸烟状况的研究时，糖尿病与肺癌风险增加显著相关（RR，1.11；95%CI，1.02-1.20；I²=46.1%）。相比之下，当分析仅限于未调整吸烟状况的研究时，这种关联消失（RR，0.99；95%CI，0.88-1.11；I²=96.7%）。按性别分层时，糖尿病女性的肺癌风险显著增加（RR，1.14；95%CI，1.09-1.20；I²=0%），而糖尿病男性则无关联（RR，1.07；95%CI，0.89-1.28；I²=96.6%）。在糖尿病女性中，在以下亚组中发现了肺癌风险的显著增加：队列研究（RR，1.14；95%CI，1.08-1.20；I²=0%）、控制年龄、吸烟和饮酒等主要混杂变量的研究（RR，1.19；95%CI，1.00-1.43；I²=23.1%）、随访时间较长的研究（RR，1.14；95%CI，1.08-1.20；I²=0%）和使用纽卡斯尔-渥太华量表（NOS）评估的高质量研究（RR，1.14；95%CI，1.08-1.20；I²=0%）。