Prego-Domínguez Jesús, Takkouche Bahi
Department of Preventive Medicine, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain.
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), 28029 Madrid, Spain.
J Clin Med. 2021 May 30;10(11):2429. doi: 10.3390/jcm10112429.
Hematologic malignancies cause more than half a million deaths every year worldwide. Analgesics were suggested as chemopreventive agents for several cancers but so far, results from individual studies about the relationship between paracetamol (acetaminophen) use and hematologic malignancies are conflicting. Therefore, we decided to perform a systematic review and meta-analysis. We retrieved studies published in any language by systematically searching Medline, Embase, Conference Proceedings Citation Index, Open Access Theses and Dissertations, and the five regional bibliographic databases of the World Health Organization until December 2020. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated according to the inverse of their variances. We performed separate analyses by histologic type. We also evaluated publication bias and assessed quality. A total of 17 study units met our inclusion criteria. The results show an association of hematologic malignancies with any paracetamol intake (OR 1.49, 95% CI 1.23-1.80) and with high paracetamol intake (OR 1.77, 95% CI 1.45-2.16). By subtype, risk was higher for multiple myeloma (OR 2.13, 95% CI 1.54-2.94) for any use and OR 3.16, 95% CI 1.96-5.10 for high intake, while risk was lower and non-significant for non-Hodgkin lymphoma. This meta-analysis provides evidence that paracetamol intake may be associated with hematologic malignancies and suggests that a dose-response effect is plausible. These results are unlikely to be due to publication bias or low quality of studies. Future research should focus on assessing the dose-response relationship.
血液系统恶性肿瘤每年在全球导致超过50万人死亡。镇痛药被认为是几种癌症的化学预防剂，但到目前为止，关于对乙酰氨基酚（扑热息痛）使用与血液系统恶性肿瘤之间关系的个体研究结果相互矛盾。因此，我们决定进行一项系统评价和荟萃分析。我们通过系统检索Medline、Embase、会议论文引文索引、开放获取学位论文以及世界卫生组织的五个区域书目数据库，检索截至2020年12月以任何语言发表的研究。根据方差的倒数计算合并优势比（OR）及其95%置信区间（CI）。我们按组织学类型进行了单独分析。我们还评估了发表偏倚并评估了质量。共有17个研究单位符合我们的纳入标准。结果显示血液系统恶性肿瘤与任何对乙酰氨基酚摄入量（OR 1.49，95%CI 1.23 - 1.80）以及高对乙酰氨基酚摄入量（OR 1.77，95%CI 1.45 - 2.16）之间存在关联。按亚型划分，对于任何使用情况，多发性骨髓瘤的风险更高（OR 2.13，95%CI 1.54 - 2.94），高摄入量时OR为3.16，95%CI 1.96 - 5.10，而非霍奇金淋巴瘤的风险较低且无统计学意义。这项荟萃分析提供了证据表明对乙酰氨基酚摄入可能与血液系统恶性肿瘤有关，并表明剂量反应效应是合理的。这些结果不太可能是由于发表偏倚或研究质量低所致。未来的研究应侧重于评估剂量反应关系。
