Lytras Theodore, Nikolopoulos Georgios, Bonovas Stefanos
Theodore Lytras, Department of Occupational and Industrial Hygiene, National School of Public Health, 11521 Athens, Greece.
World J Gastroenterol. 2014 Feb 21;20(7):1858-70. doi: 10.3748/wjg.v20.i7.1858.
To investigate the association between statin use and colorectal cancer risk, we conducted an updated meta-analysis of published studies.
We performed a comprehensive search for studies published up to July 2013. Eligible studies for this meta-analysis were either randomized controlled trials (RCTs) or observational studies (case-control or cohort) evaluating any exposure to statins and the risk of colorectal cancer. Two reviewers selected studies based on predefined inclusion criteria, and abstracted the data. Pooled relative risk (RR) estimates with their 95%CI were calculated using fixed- and random-effects models. Then, we assessed the potential presence of publication bias and between-studies heterogeneity. To evaluate the results, we also performed a "leave-one-out" sensitivity analysis.
A total of 40 studies, involving more than eight million subjects, contributed to the analysis. They were grouped on the basis of study design and, consequently, three separate meta-analyses were conducted. A similar modest reduction in the risk of colorectal cancer with statin use was observed, which was not statistically significant among RCTs (RR = 0.89, 95%CI: 0.74-1.07; n = 8), but reached statistical significance among cohort studies (RR = 0.91, 95%CI: 0.83-1.00; n = 13) and case-control studies (RR = 0.92, 95%CI: 0.87-0.98; n = 19). While we did not find significant evidence of selective outcome reporting or publication bias, substantial heterogeneity was detected, mainly among the observational studies. The sensitivity analysis confirmed the stability of our results.
A modest reduction in risk of colorectal cancer among statin users cannot be disproved. Further targeted research is warranted.
为研究他汀类药物使用与结直肠癌风险之间的关联，我们对已发表的研究进行了一项更新的荟萃分析。
我们全面检索了截至2013年7月发表的研究。本荟萃分析的合格研究为评估任何他汀类药物暴露与结直肠癌风险的随机对照试验（RCT）或观察性研究（病例对照或队列研究）。两名审阅者根据预先定义的纳入标准选择研究，并提取数据。使用固定效应模型和随机效应模型计算合并相对风险（RR）估计值及其95%置信区间（CI）。然后，我们评估了发表偏倚和研究间异质性的潜在存在情况。为评估结果，我们还进行了“逐一剔除”敏感性分析。
共有40项研究，涉及超过800万受试者，纳入了分析。这些研究根据研究设计进行分组，因此进行了三项独立的荟萃分析。观察到使用他汀类药物使结直肠癌风险有类似的适度降低，在随机对照试验中这一结果无统计学意义（RR = 0.89，95%CI：0.74 - 1.07；n = 8），但在队列研究（RR = 0.91，95%CI：0.83 - 1.00；n = 13）和病例对照研究（RR = 0.92，95%CI：0.87 - 0.98；n = 19）中达到统计学意义。虽然我们未发现选择性结果报告或发表偏倚的显著证据，但检测到显著的异质性，主要存在于观察性研究中。敏感性分析证实了我们结果的稳定性。
他汀类药物使用者结直肠癌风险适度降低这一结论无法被推翻。有必要进行进一步的针对性研究。
