Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China.
Center of Infectious Diseases, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China.
Eur J Clin Invest. 2021 Feb;51(2):e13434. doi: 10.1111/eci.13434. Epub 2020 Oct 29.
Current studies investigating the association between inhaled corticosteroid (ICS) use and risk of lung cancer have yielded inconsistent findings. The aim of this systematic review and meta-analysis was to pool all currently available data to estimate this association.
We systematically searched MEDLINE (1946 to July 2020), EMBASE (1974 to July 2020) and the Cochrane Library (June 2020) via Ovid to identify relevant articles investigating the association between the ICS use and the risk of lung cancer. Random-effects analysis was used to calculate pooled relative risks (RRs) with 95% confidence intervals (CIs).
Ten articles including 234 920 patients were analysed. ICS use was identified to have a decreased risk of lung cancer in chronic obstructive pulmonary disease (8 studies, 1806 patients; RR = 0.73, 95% CI: 0.61-0.87, P < .01; I = 60.0 %), asthma (1 study, 41 438 patients; RR = 0.44, 95% CI: 0.34-0.57, P < .01) and mixed (1 study, 46 225 patients; RR = 0.79, 95% CI: 0.69-0.90, P < .01) patients. The findings of reduced risk of lung cancer were consistent in all subgroup analyses except for the short-term follow-up (≤5 years) (RR = 0.94, 95% CI: 0.81-1.07, P = .34) and free of immortal time bias (RR = 0.94, 95% CI: 0.82-1.08, P = .38) subgroups.
The present study suggested that ICS use was associated with decreased risk of lung cancer. However, our findings should be interpreted with caution because most original studies were judged to be at high risk of immortal time bias.
目前研究吸入性皮质类固醇（ICS）使用与肺癌风险之间的关系得出的结果并不一致。本系统评价和荟萃分析的目的是汇总所有现有数据来评估这种关联。
我们通过 Ovid 系统地检索了 MEDLINE（1946 年至 2020 年 7 月）、EMBASE（1974 年至 2020 年 7 月）和 Cochrane 图书馆（2020 年 6 月），以确定调查 ICS 使用与肺癌风险之间关系的相关文章。使用随机效应分析计算汇总的相对风险（RR）及其 95%置信区间（CI）。
分析了 10 项包含 234920 名患者的研究。结果表明，ICS 使用可降低慢性阻塞性肺疾病（8 项研究，1806 名患者；RR=0.73，95%CI：0.61-0.87，P<.01；I²=60.0%）、哮喘（1 项研究，41438 名患者；RR=0.44，95%CI：0.34-0.57，P<.01）和混合（1 项研究，46225 名患者；RR=0.79，95%CI：0.69-0.90，P<.01）患者的肺癌风险。除短期随访（≤5 年）（RR=0.94，95%CI：0.81-1.07，P=0.34）和无不朽时间偏倚（RR=0.94，95%CI：0.82-1.08，P=0.38）亚组外，这些降低肺癌风险的发现结果在所有亚组分析中均一致。
本研究表明 ICS 使用与肺癌风险降低相关。然而，由于大多数原始研究被认为存在不朽时间偏倚的高风险，因此我们的研究结果应谨慎解释。
