Department of Health Statistics, Second Military Medical University, Shanghai, China.
State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
Colorectal Dis. 2019 Jul;21(7):748-759. doi: 10.1111/codi.14582. Epub 2019 Mar 22.
The association between the use of oral contraceptives and hormone replacement therapy (HRT) or other reproductive factors and the risk of colorectal adenoma (CRA) remains controversial. Our study aimed to review the evidence by conducting a dose-response meta-analysis to investigate this association.
We searched PubMed and Embase databases for relevant studies published until May 2017. Traditional and dose-response meta-analyses were conducted. Sensitivity analysis was performed to evaluate the robustness of the results. Cumulative meta-analysis was used to assess the risk of different oral contraceptive formulations or generations.
A total of 19 observational studies, with 21 923 CRA cases and 1 030 711 participants, were included in the meta-analysis. Ever HRT use showed a potential inverse association with CRA risk [relative risk (RR) 0.83, 95% CI 0.70-1.00]. The dose-response meta-analysis further demonstrated that HRT use could reduce CRA risk. Compared with no HRT use, the predicted RRs were 0.82 (95% CI 0.67-0.99), 0.76 (95% CI 0.59-0.98) and 0.77 (95% CI 0.62-0.96) for 3, 6 and 9 years of HRT use, respectively. All other factors were not statistically significantly associated with CRA risk.
This study indicated that only HRT use might reduce the risk of developing CRA. Any advice regarding HRT use to prevent CRA should be tailored to the individual risks and potential benefits. Large, well-designed prospective studies with long-term follow-up are required to further clarify the aetiology of CRA.
口服避孕药和激素替代疗法（HRT）或其他生殖因素的使用与结直肠腺瘤（CRA）风险之间的关联仍存在争议。本研究旨在通过剂量反应荟萃分析来审查这一关联的证据。
我们检索了 PubMed 和 Embase 数据库，以获取截至 2017 年 5 月发表的相关研究。进行了传统和剂量反应荟萃分析。进行敏感性分析以评估结果的稳健性。累积荟萃分析用于评估不同口服避孕药配方或代际的风险。
共有 19 项观察性研究，包括 21923 例 CRA 病例和 1030711 名参与者，纳入荟萃分析。HRT 使用史与 CRA 风险呈潜在负相关[相对风险（RR）0.83，95%可信区间（CI）0.70-1.00]。剂量反应荟萃分析进一步表明，HRT 使用可降低 CRA 风险。与不使用 HRT 相比，预测的 RR 分别为 0.82（95% CI 0.67-0.99）、0.76（95% CI 0.59-0.98）和 0.77（95% CI 0.62-0.96），分别为 HRT 使用 3、6 和 9 年。其他所有因素与 CRA 风险均无统计学显著相关性。
本研究表明，只有 HRT 使用可能降低 CRA 的发病风险。任何关于使用 HRT 预防 CRA 的建议都应根据个体风险和潜在获益量身定制。需要进行大型、精心设计的前瞻性研究，并进行长期随访，以进一步阐明 CRA 的病因。
