Piovani Daniele, Hassan Cesare, Repici Alessandro, Rimassa Lorenza, Carlo-Stella Carmelo, Nikolopoulos Georgios K, Riboli Elio, Bonovas Stefanos
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Gastroenterology. 2022 Sep;163(3):671-684. doi: 10.1053/j.gastro.2022.05.038. Epub 2022 May 26.
BACKGROUND & AIMS: To summarize the epidemiologic evidence and assess the validity of claimed associations of inflammatory bowel diseases (IBDs) with overall and site-specific cancer risk.
We systematically searched PubMed, Embase, and Scopus from inception to May 10, 2021, to identify and comprehensively reanalyze the data of meta-analyses on associations between IBDs (ie, Crohn's disease [CD] and ulcerative colitis [UC]) and subsequent risk of cancer. The strength of epidemiologic evidence was graded as high, moderate, or weak, by applying prespecified criteria that included the random effects estimate, its 95% confidence interval, and P value, estimates of heterogeneity, small-study effects, and robustness to unmeasured confounding.
This study critically appraised 277 estimates derived from 24 published meta-analyses and our own meta-analyses. The association between pediatric-onset IBDs and overall risk of cancer showed high epidemiologic evidence. Twenty associations (15 cancer types) demonstrated moderate evidence: any cancer (pediatric-onset UC), mouth to terminal ileum (CD), small bowel (CD/UC), colon (CD), rectum (CD/UC), colon-rectum (IBDs, pediatric-onset CD/UC), bile ducts and liver (CD/UC), liver (CD), intrahepatic cholangiocarcinoma (IBDs), bile ducts (CD), skin (CD), squamous cell carcinoma of the skin (CD), nonmelanoma skin cancer (UC), kidney (CD), and thyroid cancer (IBDs). Another 40 associations (23 cancer types) showed statistical significance; however, our confidence in these effect estimates was weak. No statistical significance was found regarding further 47 associations.
Associations between IBDs and different types of malignancy showed varying levels of evidence and magnitude of risk. Further primary research investigating the impact of a consistent set of risk factors that are known to affect cancer risk is warranted.
PROSPERO CRD42021254996.
总结炎症性肠病（IBD）与总体及特定部位癌症风险之间关联的流行病学证据，并评估所宣称关联的有效性。
我们系统检索了从数据库建立至2021年5月10日的PubMed、Embase和Scopus数据库，以识别并全面重新分析关于IBD（即克罗恩病[CD]和溃疡性结肠炎[UC]）与后续癌症风险之间关联的荟萃分析数据。通过应用预先设定的标准（包括随机效应估计值、其95%置信区间和P值、异质性估计值、小研究效应以及对未测量混杂因素的稳健性），将流行病学证据的强度分为高、中、弱三个等级。
本研究严格评估了来自24篇已发表的荟萃分析以及我们自己的荟萃分析得出的277个估计值。儿童期发病的IBD与总体癌症风险之间的关联显示出高流行病学证据。20个关联（15种癌症类型）显示出中等证据：任何癌症（儿童期发病的UC）、口腔至回肠末端（CD）、小肠（CD/UC）、结肠（CD）、直肠（CD/UC）、结肠 - 直肠（IBD、儿童期发病的CD/UC）、胆管和肝脏（CD/UC）、肝脏（CD）、肝内胆管癌（IBD）、胆管（CD）、皮肤（CD）、皮肤鳞状细胞癌（CD）、非黑色素瘤皮肤癌（UC）、肾脏（CD）和甲状腺癌（IBD）。另外40个关联（23种癌症类型）具有统计学意义；然而，我们对这些效应估计值的信心较弱。另外47个关联未发现统计学意义。
IBD与不同类型恶性肿瘤之间的关联显示出不同程度的证据和风险大小。有必要开展进一步的基础研究，以调查一组已知会影响癌症风险的一致风险因素的影响。
PROSPERO CRD42021254996
