Huang Pei, Yang Xiao-Dong, Chen Sheng-Di, Xiao Qin
Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025 China.
Transl Neurodegener. 2015 Nov 3;4:21. doi: 10.1186/s40035-015-0044-y. eCollection 2015.
To assess the association between Parkinson's disease (PD) and melanoma via systematic review and meta-analysis.
Comprehensive search in PubMed, Web of Science, Embase and four China databases (SinoMed, WanFang data, CNKI and VIP database) of epidemiologic evidences on PD and melanoma published before April 30, 2015. Studies which reported risk estimates of melanoma among PD patients or risk estimates of PD in patients with melanoma were included. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated by random-effects models. Heterogeneity across studies was assessed using Cochran Q and I(2) statistics. Subgroup analyses and sensitivity analyses were conducted to evaluate sources of heterogeneity. Subgroup analyses were done according to temporal relationship, geographic region and gender respectively. We assessed publication bias using the Begg and Egger test. In addition, study appraisal was done using a scale for observational studies to ensure the quality of evidence.
We identified 24 eligible studies on PD and melanoma with a total number of 292,275 PD patients: the pooled OR was 1.83 (95 % CI 1.46-2.30) overall, subgroup analyses by temporal relationship showed that risk of melanoma after PD diagnosis was significantly higher (OR 2.43, 95 % CI 1.77-3.32), but not before the diagnosis of PD (OR 1.09, 95 % CI 0.78-1.54). Subgroup analysis by geographic region showed that increased risk of melanoma in PD was found both in Europe (OR 1.44, 95 % CI 1.22-1.70) and in North America (OR 2.64, 95 % CI 1.63-4.28). Gender-specific subgroup analyses did not show difference between men (OR 1.64, 95 % CI 1.27-2.13) and women (OR 1.38, 95 % CI 1.04-1.82) in the risk of melanoma. In addition, we found the risk of non-melanoma skin cancers in PD was slightly higher (OR 1.20, 95 % CI 1.11-1.29) than general population. It was impossible to evaluate the association between PD and melanoma according to use of levodopa or gene polymorphism via meta-analysis since few observational or cohort studies have focused on it.
An association between PD and melanoma was confirmed. Most of the evidences were of high quality, and the conclusion was robust. Further research is needed to explore the mechanisms underlying this relationship.
通过系统评价和荟萃分析评估帕金森病（PD）与黑色素瘤之间的关联。
全面检索PubMed、科学网、Embase以及四个中国数据库（中国生物医学文献数据库、万方数据、中国知网和维普数据库），查找2015年4月30日前发表的关于PD和黑色素瘤的流行病学证据。纳入报告PD患者中黑色素瘤风险估计值或黑色素瘤患者中PD风险估计值的研究。采用随机效应模型计算合并比值比（OR）及95%置信区间（CI）。使用Cochran Q和I²统计量评估研究间的异质性。进行亚组分析和敏感性分析以评估异质性来源。亚组分析分别根据时间关系、地理区域和性别进行。采用Begg和Egger检验评估发表偏倚。此外，使用观察性研究量表进行研究评估以确保证据质量。
我们确定了24项关于PD和黑色素瘤的合格研究，共有292275例PD患者：总体合并OR为1.83（95%CI 1.46 - 2.30），按时间关系进行的亚组分析显示，PD诊断后黑色素瘤风险显著更高（OR 2.43，95%CI 1.77 - 3.32），但在PD诊断前则不然（OR 1.09，95%CI 0.78 - 1.54）。按地理区域进行的亚组分析显示，欧洲（OR 1.44，95%CI 1.22 - 1.70）和北美（OR 2.64，95%CI 1.63 - 4.28）的PD患者中黑色素瘤风险均增加。按性别进行的亚组分析未显示男性（OR 1.64，95%CI 1.27 - 2.13）和女性（OR 1.38，95%CI 1.04 - 1.82）在黑色素瘤风险上存在差异。此外，我们发现PD患者中非黑色素瘤皮肤癌的风险略高于一般人群（OR 1.20，95%CI 1.11 - 1.29）。由于很少有观察性或队列研究关注这一点，因此无法通过荟萃分析评估使用左旋多巴或基因多态性与PD和黑色素瘤之间的关联。
证实了PD与黑色素瘤之间存在关联。大多数证据质量较高，结论可靠。需要进一步研究探索这种关系背后的机制。
