Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
Cancer Causes Control. 2021 Oct;32(10):1047-1061. doi: 10.1007/s10552-021-01472-8. Epub 2021 Jul 5.
Evidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This systematic review summarizes the evidence on medication use and proximal colon cancer risk.
MEDLINE and EMBASE were searched for prospective studies investigating nine medication groups, namely non-steroidal anti-inflammatory drugs (NSAIDs), exogenous hormones, i.e., hormone replacement therapy (HRT) or oral contraceptives (OCs), statins, proton pump inhibitors, anti-hypertensives, metformin (an antidiabetic), antidiarrheals or laxatives, and the risk of proximal colon cancer. Narrative synthesis and meta-analyses, using random effects models to estimate risk ratios (RRs) and 95% confidence intervals (CIs), were conducted.
Twenty nine publications investigating NSAIDs (n = 13), exogenous hormones [HRT (n = 9) or OCs (n = 4)] statins (n = 5), anti-hypertensives (n = 1), and metformin (n = 1) were included. Summary RRs reported a protective effect of aspirin use (RR 0.80, 95% CI 0.73-0.89) but no associations between HRT (RR 0.92, 95% CI 0.83-1.02), OC (RR 1.06, 95% CI 0.98-1.14) or statin use (RR 0.94, 95% CI 0.67-1.31), and proximal colon cancer incidence compared to never/non-use. One study on metformin and one on anti-hypertensives reported no association. Sources of between-study heterogeneity included study design, period of exposure ascertainment, exposure source, and exposure comparison, but this exploration was hindered by the small numbers of studies.
Despite some studies on NSAID or HRT use, evidence on the impact of a range of medications on proximal colon cancer risk is limited. This highlights the need for more research to inform chemoprevention strategies.
近端结肠癌的病因和存活率与远端结直肠癌相比存在差异，这需要对其危险因素进行研究。本系统综述总结了药物使用与近端结肠癌风险的证据。
在 MEDLINE 和 EMBASE 中搜索了 9 种药物组的前瞻性研究，包括非甾体抗炎药（NSAIDs）、外源性激素，即激素替代疗法（HRT）或口服避孕药（OCs）、他汀类药物、质子泵抑制剂、抗高血压药、二甲双胍（一种降糖药）、止泻药或泻药，以及近端结肠癌的风险。采用随机效应模型估计风险比（RR）和 95%置信区间（CI），进行叙述性综合和荟萃分析。
共纳入 29 项研究 NSAIDs（n=13）、外源性激素[HRT（n=9）或 OCs（n=4）]、他汀类药物（n=5）、抗高血压药（n=1）和二甲双胍（n=1）。报告的汇总 RR 显示，阿司匹林使用具有保护作用（RR 0.80，95%CI 0.73-0.89），但 HRT（RR 0.92，95%CI 0.83-1.02）、OC（RR 1.06，95%CI 0.98-1.14）或他汀类药物使用（RR 0.94，95%CI 0.67-1.31）与近端结肠癌发生率之间无关联。一项关于二甲双胍和一项关于抗高血压药的研究报告没有关联。研究之间的异质性来源包括研究设计、暴露确定时期、暴露源和暴露比较，但由于研究数量较少，这种探索受到阻碍。
尽管有一些关于 NSAID 或 HRT 使用的研究，但关于一系列药物对近端结肠癌风险影响的证据有限。这凸显了需要更多的研究来为化学预防策略提供信息。
