CT 扫描与癌症风险：系统评价和剂量反应荟萃分析。
CT Scans and Cancer Risks: A Systematic Review and Dose-response Meta-analysis.
机构信息
Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Hua Road, No. 439, Yongchuan, 402160, Chongqing, People's Republic of China.
Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian District, Xi'an, 712046, Shaanxi Province, People's Republic of China.
出版信息
BMC Cancer. 2022 Nov 30;22(1):1238. doi: 10.1186/s12885-022-10310-2.
BACKGROUND
There is still uncertainty on whether ionizing radiation from CT scans can increase the risks of cancer. This study aimed to identify the association of cumulative ionizing radiation from CT scans with pertaining cancer risks in adults.
METHODS
Five databases were searched from their inception to November 15, 2020. Observational studies reporting cancer risks from CT scans in adults were included. The main outcome included quantified cancer risks as cancer case numbers in exposed/unexposed adult participants with unified converted measures to odds ratio (OR) for relative risk, hazard ratio. Global background radiation (2.4 mSv per year) was used as control for lifetime attribution risk (LAR), with the same period from incubation after exposure until survival to 100 years.
RESULTS
25 studies were included with a sum of 111,649,943 participants (mean age: 45.37 years, 83.4% women), comprising 2,049,943 actual participants from 6 studies with an average follow-up period as 30.1 years (range, 5 to 80 years); 109,600,000 participants from 19 studies using LAR. The cancer risks for adults following CT scans were inordinately increased (LAR adults, OR, 10.00 [95% CI, 5.87 to 17.05]; actual adults, OR, 1.17 [95%CI, 0.89 to 1.55]; combined, OR, 5.89 [95%CI, 3.46 to 10.35]). Moreover, cancer risks elevated with increase of radiation dose (OR, 33.31 [95% CI, 21.33 to 52.02]), and multiple CT scan sites (OR, 14.08 [95% CI, 6.60 to 30.05]). The risk of solid malignancy was higher than leukemia. Notably, there were no significant differences for age, gender, country, continent, study quality and studying time phrases.
CONCLUSIONS
Based on 111.6 million adult participants from 3 continents (Asia, Europe and America), this meta-analysis identifies an inordinately increase in cancer risks from CT scans for adults. Moreover, the cancer risks were positively correlated with radiation dose and CT sites. The meta-analysis highlights the awareness of potential cancer risks of CT scans as well as more reasonable methodology to quantify cancer risks in terms of life expectancy as 100 years for LAR.
PROSPERO TRIAL REGISTRATION NUMBER
CRD42019133487.
背景
CT 扫描产生的电离辐射是否会增加癌症风险仍存在不确定性。本研究旨在确定 CT 扫描累积电离辐射与成年人相关癌症风险之间的关联。
方法
从建库开始至 2020 年 11 月 15 日，在五个数据库中进行检索。纳入了报告 CT 扫描致成年人癌症风险的观察性研究。主要结局为暴露/未暴露于 CT 扫描的成年参与者中经统一转换为比值比（OR）的癌症风险病例数，用于相对风险和危害比。全球本底辐射（每年 2.4mSv）被用作终生归因风险（LAR）的对照，暴露后潜伏期到 100 岁的时间与 LAR 相同。
结果
共纳入 25 项研究，涉及 111649943 名参与者（平均年龄：45.37 岁，83.4%为女性），其中 6 项研究中有 2049943 名实际参与者，平均随访时间为 30.1 年（范围：5-80 年）；19 项研究采用 LAR，参与者 109600000 名。CT 扫描后成年人癌症风险显著增加（LAR 成人 OR 为 10.00 [95%CI，5.87 至 17.05]；实际成人 OR 为 1.17 [95%CI，0.89 至 1.55]；合并 OR 为 5.89 [95%CI，3.46 至 10.35]）。此外，癌症风险随辐射剂量（OR 为 33.31 [95%CI，21.33 至 52.02]）和多个 CT 扫描部位（OR 为 14.08 [95%CI，6.60 至 30.05]）的增加而升高。实体恶性肿瘤的风险高于白血病。值得注意的是，年龄、性别、国家、大洲、研究质量和研究时间等因素之间无显著差异。
结论
本荟萃分析基于来自三大洲（亚洲、欧洲和美洲）的 11160 万名成年参与者，确定 CT 扫描致成年人癌症风险显著增加。此外，癌症风险与辐射剂量和 CT 扫描部位呈正相关。该荟萃分析强调了 CT 扫描潜在癌症风险的意识，以及更合理的方法来量化以 100 岁预期寿命为基础的癌症风险。
临床试验注册号
CRD42019133487。
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