Yu Wenqian, Zhou Jin, Luo Jing, Xia Jing, Li Shiyi, Xie Linjun, He YaZhou, Li Hongyu, Jiang Guoheng, Chen Xin, Bai Xuan, Mao Min, Wang Xin
Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, P. R. China.
West China-PUMC C. C. Chen Institute of Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, P. R. China.
Cancer Med. 2025 May;14(9):e70857. doi: 10.1002/cam4.70857.
Increasing evidence connects gallstone disease (GSD) to all types of cancer incidence; however, the results were inconsistent. The present study aimed to evaluate whether and to what extent these associations exist comprehensively.
We systematically searched published longitudinal studies indexed in PubMed and Embase database from dates of inception to March 31, 2020. We pooled the effect of GSD on all-cause cancer incidence. Moreover, we further employed stratified analysis concerning sex, geographic background, surgery status, and follow-up period. Trial sequential analysis (TSA) was applied to decide whether the included sample size was sufficient for evaluating these associations.
Fifty-one studies incorporating over 13 million participants were eligible for analysis in this study. GSD pose an increased risk of all-cause cancer risk (pooled RR = 1.43; 95% CI: 1.33-1.54) compared with the healthy controls, especially hematologic malignancy (pooled RR = 1.14; 95% CI: 1.05-1.25), gastrointestinal cancers (pooled RR = 1.28; 95% CI: 1.15-1.41), liver, pancreas, and biliary tract cancer (pooled RR = 1.84; 95% CI: 1.62-2.10), and kidney cancer (pooled RR = 1.19; 95% CI: 1.03-1.37). These associations are not markedly changed after stratification by different subgroups. Moreover, the TSA confirmed the sample size was sufficient to draw these conclusive conclusions.
The present meta-analysis with sufficient evidence indicates GSD increases the risk for all causes of cancer incidence. The evidence may warrant GSD patients to perform screening and prophylactic treatment for the prevention of these complications. The indication for cholecystectomy should be determined through a comprehensive evaluation of the patient's clinical presentation, with a thorough assessment of the potential therapeutic benefits and surgical risks.
越来越多的证据表明胆结石疾病（GSD）与所有类型癌症的发病率相关；然而，结果并不一致。本研究旨在全面评估这些关联是否存在以及存在的程度。
我们系统检索了从数据库建立至2020年3月31日在PubMed和Embase数据库中索引的已发表纵向研究。我们汇总了GSD对全因癌症发病率的影响。此外，我们进一步按性别、地理背景、手术状态和随访期进行分层分析。应用试验序贯分析（TSA）来确定纳入的样本量是否足以评估这些关联。
本研究中有51项纳入超过1300万参与者的研究符合分析条件。与健康对照相比，GSD增加了全因癌症风险（合并相对风险度RR = 1.43；95%置信区间CI：1.33 - 1.54），尤其是血液系统恶性肿瘤（合并RR = 1.14；95% CI：1.05 - 1.25）、胃肠道癌症（合并RR = 1.28；95% CI：1.15 - 1.41）、肝脏、胰腺和胆道癌（合并RR = 1.84；95% CI：1.62 - 2.10）以及肾癌（合并RR = 1.19；95% CI：1.03 - 1.37）。在按不同亚组分层后，这些关联没有明显变化。此外，TSA证实样本量足以得出这些结论性结果。
本项有充分证据的荟萃分析表明，GSD会增加所有原因导致的癌症发病率风险。该证据可能使GSD患者有必要进行筛查和预防性治疗以预防这些并发症。胆囊切除术的指征应通过对患者临床表现的全面评估来确定，同时要对潜在的治疗益处和手术风险进行全面评估。
