Yang Yuan, Zhang Fan, Skrip Laura, Lei Han, Luo Suxin, Lu Kai, Hu Dayi
Department of Cardiovascular Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
School of Public Health and Health Management, Chongqing Medical University, Chongqing, China.
PLoS One. 2015 Mar 19;10(3):e0119775. doi: 10.1371/journal.pone.0119775. eCollection 2015.
A previous meta-analysis of randomized controlled studies that were not designed to investigate cancer as a primary outcome suggested that ARB-based therapy is associated with increased risk of cancer; however, results of recent observational studies considering the association have been contradictory. This study sought to evaluate the association between angiotensin receptor blocker (ARB)-based therapy and risk of cancer by conducting a meta-analysis of observational studies.
Relevant articles published before February 2014 were identified by searching PubMed and the Cochrane Library. Pooled relative risks (RRs) were determined using a random effects model and were used to assess the strength of association between use of ARB-based therapy and risk of cancer.
Six retrospective cohort studies involving a total of 3,827,109 participants and four case-control studies involving a total of 193,029 cases were included. The present study found that ARB-based therapy was not significantly associated with an increased risk of cancer (RR = 0.87, 95%CI: [0.75, 1.01]). However, an analysis including only cohort studies suggested a significantly decreased risk of cancer among individuals with any history of ARB use as compared to those with no history of ARB use (RR = 0.80, 95%CI: [0.55, 0.95]); no significant association was found between ARB use and risk of cancer when the case-control studies were separately considered (RR = 1.03, 95%CI: [0.93, 1.13]). Subgroup analyses showed that use of ARB-based therapy was associated with decreased risk of lung cancer (RR = 0.81, 95%CI: [0.69, 0.94]); however, no significant associations were found with the other cancer sites investigated. Furthermore, no association was observed upon adjustment by type of ARB drug. No publication bias was detected.
Overall, ARB-based therapy was not associated with increased risk of cancer. However, its use may be related to decreased incidence of lung cancer; this finding should be considered carefully and confirmed with further studies.
先前一项针对并非旨在将癌症作为主要结局进行研究的随机对照研究的荟萃分析表明，基于血管紧张素受体阻滞剂（ARB）的治疗与癌症风险增加相关；然而，近期考虑该关联的观察性研究结果相互矛盾。本研究旨在通过对观察性研究进行荟萃分析，评估基于ARB的治疗与癌症风险之间的关联。
通过检索PubMed和Cochrane图书馆，确定2014年2月之前发表的相关文章。使用随机效应模型确定合并相对风险（RRs），并用于评估基于ARB的治疗使用与癌症风险之间的关联强度。
纳入了6项涉及总共3,827,109名参与者的回顾性队列研究和4项涉及总共193,029例病例的病例对照研究。本研究发现，基于ARB的治疗与癌症风险增加无显著关联（RR = 0.87，95%CI：[0.75, 1.01]）。然而，仅纳入队列研究的分析表明，与无ARB使用史的个体相比，有任何ARB使用史的个体患癌风险显著降低（RR = 0.80，95%CI：[0.55, 0.95]）；单独考虑病例对照研究时，未发现ARB使用与癌症风险之间存在显著关联（RR = 1.03，95%CI：[0.93, 1.13]）。亚组分析表明，基于ARB的治疗使用与肺癌风险降低相关（RR = 0.81，95%CI：[0.69, 0.94]）；然而，在所研究的其他癌症部位未发现显著关联。此外，按ARB药物类型进行调整后未观察到关联。未检测到发表偏倚。
总体而言，基于ARB的治疗与癌症风险增加无关。然而，其使用可能与肺癌发病率降低有关；这一发现应仔细考虑并通过进一步研究加以证实。
