Yeo Brian Sheng Yep, Yap Dominic Wei Ting, Tan Nicole Kye Wen, Tan Benjamin Kye Jyn, Teo Yao Hao, Teo Yao Neng, Lee Alvin, See Anna, Ho Henry Sun Sien, Teoh Jeremy Yuen-Chun, Chen Kenneth, Toh Song Tar
Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.
Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore; Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore; Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore.
Eur Urol Focus. 2024 Dec;10(6):958-971. doi: 10.1016/j.euf.2024.07.004. Epub 2024 Aug 1.
While obstructive sleep apnea (OSA) and urological cancer are both strongly associated with hypoxia, controversy exists regarding their association with each other. This study aims to summarize and synthesize evidence to clarify the association between OSA and urological cancer incidence and mortality.
According to a prespecified protocol, PubMed, Embase, Cochrane Library, and Scopus were searched from inception to November 16, 2023, for observational and randomized studies reporting the association of OSA with urological cancer incidence or mortality. We pooled maximally covariate-adjusted hazard ratios (HRs) using a random-effects inverse variance-weighted model. Two reviewers independently assessed the quality of evidence using the Newcastle-Ottawa Scale and the Grading of Recommendations, Assessment, Development and Evaluation framework.
From 1814 records, we included 12 studies comprising 9 290 818 participants in total, of which nine studies were analyzed quantitatively. OSA patients had an increased risk of kidney (HR: 1.75, 95% confidence interval [CI]: 1.21-2.53) and bladder (HR: 1.76, 95% CI: 1.05-2.96) cancer. However, OSA was not associated with prostate cancer incidence (HR: 1.29, 95% CI: 0.82-2.04). We systematically reviewed evidence surrounding OSA and testicular cancer incidence and urological cancer mortality.
OSA may be associated with a higher risk of kidney and bladder cancer, but not prostate cancer. Future work may help clarify the possibility of a dose-response relationship between OSA and urological cancer, and the effect of OSA treatment on urological cancer incidence or progression.
This research highlights a potential longitudinal association between OSA and kidney and bladder cancer, but not prostate cancer.
虽然阻塞性睡眠呼吸暂停（OSA）和泌尿系统癌症都与缺氧密切相关，但它们之间的关联仍存在争议。本研究旨在总结和综合证据，以阐明OSA与泌尿系统癌症发病率和死亡率之间的关联。
根据预先制定的方案，检索了PubMed、Embase、Cochrane图书馆和Scopus数据库，时间范围从创建到2023年11月16日，以查找报告OSA与泌尿系统癌症发病率或死亡率关联的观察性和随机研究。我们使用随机效应逆方差加权模型汇总了最大程度协变量调整后的风险比（HRs）。两名评审员使用纽卡斯尔-渥太华量表和推荐分级、评估、制定与评价框架独立评估证据质量。
从1814条记录中，我们纳入了12项研究，共计9290818名参与者，其中9项研究进行了定量分析。OSA患者患肾癌（HR：1.75，95%置信区间[CI]：1.21 - 2.53）和膀胱癌（HR：1.76，95%CI：1.05 - 2.96）的风险增加。然而，OSA与前列腺癌发病率无关（HR：1.29，95%CI：0.82 - 2.04）。我们系统地回顾了围绕OSA与睾丸癌发病率以及泌尿系统癌症死亡率的证据。
OSA可能与肾癌和膀胱癌的较高风险相关，但与前列腺癌无关。未来的研究可能有助于阐明OSA与泌尿系统癌症之间剂量反应关系的可能性，以及OSA治疗对泌尿系统癌症发病率或进展的影响。
本研究强调了OSA与肾癌和膀胱癌之间潜在的纵向关联，但与前列腺癌无关。
