The Association Between Vasectomy and Prostate Cancer A Systematic Review and Meta-analysis
The Association Between Vasectomy and Prostate Cancer A Systematic Review and Meta-analysis
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DOI：
10.1001/jamainternmed.2017.2791
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发表时间：
2017-09-01
影响因子：
39
通讯作者：
Karnes, R. Jeffrey
中科院分区：
文献类型：
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作者：
Bhindi, Bimal;Wallis, Christopher J. D.;Karnes, R. Jeffrey
重要性尽管经过了30年的研究，但关于输精管结扎术是否与前列腺癌相关的争论仍在继续。目的确定输精管结扎术是否与前列腺癌相关。DATA来源：检索MEDLINE、EMBASE、Web of Science和Scope us数据库，检索从数据库建立到2017年3月21日的研究，没有语言限制。研究选择队列、病例对照和报告输精管切除术与前列腺癌关联的横断面研究。DATA提取和合成两名研究人员独立进行研究选择。使用随机效应模型按研究设计类型分别收集数据。纽卡斯尔-渥太华量表被用来评估偏见的风险。主要结果和衡量结果是任何前列腺癌的诊断。结果共纳入53项研究(16项队列研究，2 563 519名参与者；33项病例对照研究，44 536名参与者；4项横断面研究，12098 221名参与者)。在这些研究中，7项队列研究(44%)、26项病例对照研究(79%)和所有4项横断面研究都被认为存在中度到高度的偏倚风险。在被认为具有低偏倚风险的研究中，在队列研究中发现了弱相关性(7项研究；调整后的比率比，1.05；95%可信区间，1.02-1.09；P<；.001；I-2=9%)，在病例对照研究中发现了类似但不显著的关联(6项研究，调整后的优势比，1.06；95%可信区间，0.88-1.29；P=.54；I-2=37%)。当纳入具有中到高偏倚风险的研究时，效果估计进一步偏离零。输精管结扎术与高级别前列腺癌(6项研究；调整后比率比，1.03；95%可信区间，0.89-1.21；P=.67；I-2=55%)、晚期前列腺癌(6项研究，调整比率比，1.08；95%可信区间，0.98-1.20；P=.11；I-2=18%)，以及致命性前列腺癌(5项研究，调整比率比，1.02；95%可信区间，0.92-1.14；P=.68；I-2=26%)无显著意义(所有队列研究)。基于这些数据，计算出输精管结扎术后前列腺癌的终生风险绝对值增加0.6%(95%可信区间，0.3%-1.2%)，人群归因率为0.5%(95%可信区间，0.2%-0.9%)。结论：本综述未发现输精管结扎术与高级别、晚期或致命性前列腺癌之间的相关性。输精管结扎术与任何更接近零的前列腺癌之间的相关性很弱，研究设计越来越有力。这种关联不太可能是因果关系，不应排除使用输精管结扎术作为一种长期避孕选择。
IMPORTANCE Despite 3 decades of study, there remains ongoing debate regarding whether vasectomy is associated with prostate cancer.OBJECTIVE To determine if vasectomy is associated with prostate cancer.DATA SOURCES The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched for studies indexed from database inception to March 21, 2017, without language restriction.STUDY SELECTION Cohort, case-control, and cross-sectional studies reporting relative effect estimates for the association between vasectomy and prostate cancer were included.DATA EXTRACTION AND SYNTHESIS Two investigators performed study selection independently. Data were pooled separately by study design type using random-effects models. The Newcastle-Ottawa Scale was used to assess risk of bias.MAIN OUTCOMES AND MEASURES The primary outcomewas any diagnosis of prostate cancer. Secondary outcomes were high-grade, advanced, and fatal prostate cancer.RESULTS Fifty-three studies (16 cohort studies including 2 563 519 participants, 33 case-control studies including 44 536 participants, and 4 cross-sectional studies including 12 098 221 participants) were included. Of these, 7 cohort studies (44%), 26 case-control studies (79%), and all 4 cross-sectional studies were deemed to have a moderate to high risk of bias. Among studies deemed to have a low risk of bias, a weak association was found among cohort studies (7 studies; adjusted rate ratio, 1.05; 95% CI, 1.02-1.09; P < .001; I-2 = 9%) and a similar but nonsignificant association was found among case-control studies (6 studies; adjusted odds ratio, 1.06; 95% CI, 0.88-1.29; P = .54; I-2 = 37%). Effect estimates were further from the null when studies with a moderate to high risk of bias were included. Associations between vasectomy and high-grade prostate cancer (6 studies; adjusted rate ratio, 1.03; 95% CI, 0.89-1.21; P = .67; I-2 = 55%), advanced prostate cancer (6 studies; adjusted rate ratio, 1.08; 95% CI, 0.98-1.20; P = .11; I-2 = 18%), and fatal prostate cancer (5 studies; adjusted rate ratio, 1.02; 95% CI, 0.92-1.14; P = .68; I-2 = 26%) were not significant (all cohort studies). Based on these data, a 0.6%(95% CI, 0.3%-1.2%) absolute increase in lifetime risk of prostate cancer associated with vasectomy and a population-attributable fraction of 0.5%(95% CI, 0.2%-0.9%) were calculated.CONCLUSIONS AND RELEVANCE This review found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. There was a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design. This association is unlikely to be causal and should not preclude the use of vasectomy as a long-term contraceptive option.