Cryptorchidism and testicular germ cell tumors: comprehensive meta-analysis reveals that association between these conditions diminished over time and is modified by clinical characteristics.
Cryptorchidism and testicular germ cell tumors: comprehensive meta-analysis reveals that association between these conditions diminished over time and is modified by clinical characteristics.
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DOI：
10.3389/fendo.2012.00182
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发表时间：
2012
影响因子：
5.2
通讯作者：
Cortessis VK
中科院分区：
文献类型：
--
作者：
Banks K;Tuazon E;Berhane K;Koh CJ;De Filippo RE;Chang A;Kim SS;Daneshmand S;Davis-Dao C;Lewinger JP;Bernstein L;Cortessis VK
简介：流行病学研究中，睾丸生殖细胞肿瘤 (TGCT) 的风险始终与隐睾 (CO) 病史相关。影响该关联的因素可能会提供有关 TGCT 病因学的见解，并为 CO 个体化护理提供依据。为了确定 CO-TGCT 关联的影响因素，我们对流行病学数据进行了全面的定量评估。材料和方法：对截至 2011 年 12 月 PubMed 或 ISI Web of Science 索引中引用的人体研究以及选定的未发表的流行病学数据进行了审查，以确定 35 篇文章和一个未发表的数据集，其中包含关于 CO-TGCT 关联的高质量数据。关联数据被提取为比值比 (OR) 或标准化发生率 (SIR) 的点和 95% 置信区间估计值，或作为表格数据。记录每个研究人群以及由研究设计、CO 和 TGCT 特征定义的亚组的值。提取的数据用于估计汇总风险比 (sRR) 并评估亚组之间 CO-TGCT 关联的异质性。结果：总体荟萃分析显示，CO 病史与 TGCT 风险增加四倍相关 [RR = 4.1（95% CI = 3.6–4.7）]。亚组分析确定了更强关联的五个决定因素：双侧 CO、TGCT 同侧单侧 CO、延迟 CO 治疗、1970 年之前诊断的 TGCT 以及精原细胞瘤组织学。结论：修改因素可能有助于深入了解 TGCT 病因，并提出改进 CO 管理方法。根据现有数据，CO 患者及其父母或护理人员应意识到睾丸固定术后 TGCT 风险升高，无论修复年龄、单侧与双侧未下降或睾丸未降的位置如何。
Introduction: Risk of testicular germ cell tumors (TGCT) is consistently associated with a history of cryptorchidism (CO) in epidemiologic studies. Factors modifying the association may provide insights regarding etiology of TGCT and suggest a basis for individualized care of CO. To identify modifiers of the CO-TGCT association, we conducted a comprehensive, quantitative evaluation of epidemiologic data. Materials and Methods: Human studies cited in PubMed or ISI Web of Science indices through December 2011 and selected unpublished epidemiologic data were reviewed to identify 35 articles and one unpublished dataset with high-quality data on the CO-TGCT association. Association data were extracted as point and 95% confidence interval estimates of odds ratio (OR) or standardized incidence ratio (SIR), or as tabulated data. Values were recorded for each study population, and for subgroups defined by features of study design, CO and TGCT. Extracted data were used to estimate summary risk ratios (sRR) and evaluate heterogeneity of the CO-TGCT association between subgroups. Results: The overall meta-analysis showed that history of CO is associated with four-fold increased TGCT risk [RR = 4.1(95% CI = 3.6–4.7)]. Subgroup analyses identified five determinants of stronger association: bilateral CO, unilateral CO ipsilateral to TGCT, delayed CO treatment, TGCT diagnosed before 1970, and seminoma histology. Conclusions: Modifying factors may provide insight into TGCT etiology and suggest improved approaches to managing CO. Based on available data, CO patients and their parents or caregivers should be made aware of elevated TGCT risk following orchidopexy, regardless of age at repair, unilateral vs. bilateral non-descent, or position of undescended testes.