DerSimonian R, Clemens J, Spirtas R, Perlman J
National Institute of Child Health and Human Development, Bethesda, MD 20892.
J Clin Epidemiol. 1993 Feb;46(2):163-72. doi: 10.1016/0895-4356(93)90054-5.
Two recent studies have reported a significantly elevated risk of prostate cancer among vasectomized men. To assess whether the new results conflict with earlier studies that found no significant overall association, and, if so, whether such a conflict could have a methodological basis, we reviewed the six major epidemiological studies of this topic. Statistical analysis revealed significant (p < 0.01) heterogeneity among the associations in the six studies, attributable to one of the recent studies. Scrutiny of the studies for fulfillment of eight methodological standards for scientific validity revealed that no study completely fulfilled more than four standards, and that all studies were deficient in avoiding detection bias and obtaining accurate vasectomy histories. Our review indicates that the evidence on this topic is indeed conflicting, that the quality of the evidence does not resolve the conflict, and that future studies of this topic, designed to ensure scientific credibility of results, are needed.
最近的两项研究报告称，接受输精管切除术的男性患前列腺癌的风险显著升高。为了评估这些新结果是否与早期未发现显著总体关联的研究相冲突，如果存在冲突，这种冲突是否有方法学依据，我们回顾了关于该主题的六项主要流行病学研究。统计分析显示，六项研究中的关联存在显著（p < 0.01）异质性，这归因于最近的一项研究。对这些研究是否符合八项科学有效性方法学标准进行审查发现，没有一项研究完全符合超过四项标准，并且所有研究在避免检测偏倚和获取准确的输精管切除病史方面都存在缺陷。我们的综述表明，关于该主题的证据确实相互矛盾，证据质量无法解决这种冲突，因此需要开展旨在确保结果具有科学可信度的该主题未来研究。
