Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
Cancer Risk Factors and Lifestyle Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy.
Crit Rev Oncol Hematol. 2018 Feb;122:1-9. doi: 10.1016/j.critrevonc.2017.12.003. Epub 2017 Dec 13.
Several anti-hypertensive drugs have photosensitizing properties, however it remains unclear whether long-term users of these drugs are also at increased risk of skin malignancies. We conducted a literature review and meta-analysis on the association between use of anti-hypertensive drugs and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).
We searched PubMed, EMBASE, Google Scholar and the Cochrane Library, and included observational and experimental epidemiological studies published until February 28th, 2017. We calculated summary relative risk (SRR) and 95% confidence intervals (95% CI) through random effect models to estimate the risk of skin malignancies among users of the following classes of anti-hypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), calcium channel blockers (CCB) and β-blockers. We conducted sub-group and sensitivity analysis to explore causes of between-studies heterogeneity, and assessed publication bias using a funnel-plot based approach.
Nineteen independent studies were included in the meta-analysis. CCB users were at increased skin cancer risk (SRR 1.14, 95% CI 1.07-1.21), and β-blockers users were at increased risk of developing cutaneous melanoma (SRR 1.21, 95% CI 1.05-1.40), with acceptable between-studies heterogeneity (I < 50%). There was no association between thiazide diuretics, ACEi or ARB use and skin cancer risk. We found no evidence of publication bias affecting the results.
Family doctors and clinicians should inform their patients about the increased risk of skin cancer associated with the use of CCB and β-blockers and instruct them to perform periodic skin self-examination. Further studies are warranted to elucidate the observed associations.
几种抗高血压药物具有光敏性，但目前尚不清楚长期使用这些药物的患者是否也有更高的皮肤恶性肿瘤风险。我们对使用抗高血压药物与皮肤黑色素瘤和非黑色素瘤皮肤癌（NMSC）风险之间的关系进行了文献回顾和荟萃分析。
我们搜索了 PubMed、EMBASE、Google Scholar 和 Cochrane Library，并纳入了截至 2017 年 2 月 28 日发表的观察性和实验性流行病学研究。我们通过随机效应模型计算了汇总相对风险（SRR）和 95%置信区间（95%CI），以估计使用以下抗高血压药物类别的患者发生皮肤恶性肿瘤的风险：噻嗪类利尿剂、血管紧张素转换酶抑制剂（ACEi）、血管紧张素受体阻滞剂（ARB）、钙通道阻滞剂（CCB）和β-受体阻滞剂。我们进行了亚组和敏感性分析，以探讨研究间异质性的原因，并使用漏斗图基于方法评估发表偏倚。
荟萃分析纳入了 19 项独立研究。CCB 使用者的皮肤癌风险增加（SRR 1.14，95%CI 1.07-1.21），β-受体阻滞剂使用者患皮肤黑色素瘤的风险增加（SRR 1.21，95%CI 1.05-1.40），研究间异质性可接受（I<50%）。噻嗪类利尿剂、ACEi 或 ARB 使用与皮肤癌风险之间没有关联。我们没有发现影响结果的发表偏倚的证据。
家庭医生和临床医生应告知患者使用 CCB 和β-受体阻滞剂与皮肤癌风险增加有关，并指导他们进行定期皮肤自我检查。需要进一步研究阐明观察到的关联。
