Division of Internal Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
Temerty School of Medicine, University of Toronto, Toronto, ON, Canada.
BMC Pulm Med. 2022 Jul 17;22(1):275. doi: 10.1186/s12890-022-02072-1.
There has been debate on whether inhaled corticosteroids (ICS) reduce the incidence of lung cancer amongst patients with Chronic Obstructive Lung Disease (COPD). We aimed to perform a systematic review and dose-response meta-analysis on available observational data.
We performed both a dose response and high versus low random effects meta-analysis on observational studies measuring whether lung cancer incidence was lower in patients using ICS with COPD. We report relative risk (RR) with 95% confidence intervals (CI), as well as risk difference. We use the GRADE framework to report our results.
Our dose-response suggested a reduction in the incidence of lung cancer for every 500 ug/day of fluticasone equivalent ICS (RR 0.82 [95% 0.68-0.95]). Using a baseline risk of 7.2%, we calculated risk difference of 14 fewer cases per 1000 ([95% CI 24.7-3.8 fewer]). Similarly, our results suggested that for every 1000 ug/day of fluticasone equivalent ICS, there was a larger reduction in incidence of lung cancer (RR 0.68 [0.44-0.93]), with a risk difference of 24.7 fewer cases per 1000 ([95% CI 43.2-5.4 fewer]). The certainty of the evidence was low to very low, due to risk of bias and inconsistency.
There may be a reduction in the incidence for lung cancer in COPD patients who use ICS. However, the quality of the evidence is low to very low, therefore, we are limited in making strong claims about the true effect of ICS on lung cancer incidence.
关于吸入性皮质类固醇（ICS）是否会降低慢性阻塞性肺疾病（COPD）患者的肺癌发病率一直存在争议。我们旨在对现有观察数据进行系统评价和剂量反应荟萃分析。
我们对观察性研究进行了剂量反应和高与低随机效应荟萃分析，以衡量使用 ICS 的 COPD 患者的肺癌发病率是否较低。我们报告相对风险（RR）和 95%置信区间（CI），以及风险差异。我们使用 GRADE 框架报告结果。
我们的剂量反应表明，氟替卡松等效 ICS 每天增加 500ug 可降低肺癌发病率（RR 0.82 [95% CI 0.68-0.95]）。基于 7.2%的基线风险，我们计算出每 1000 人减少 14 例的风险差异（[95% CI 24.7-3.8 例]）。同样，我们的结果表明，氟替卡松等效 ICS 每天增加 1000ug 可更大程度地降低肺癌发病率（RR 0.68 [0.44-0.93]），每 1000 人减少 24.7 例的风险差异（[95% CI 43.2-5.4 例]）。由于存在偏倚和不一致性，证据的确定性为低到极低。
使用 ICS 的 COPD 患者肺癌发病率可能降低。然而，证据质量为低到极低，因此，我们对 ICS 对肺癌发病率的真实影响做出强有力的结论是有限的。
