Study designs may influence results: the problems with questionnaire-based case-control studies on the epidemiology of glioma.
Study designs may influence results: the problems with questionnaire-based case-control studies on the epidemiology of glioma.
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DOI：
10.1038/bjc.2017.46
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发表时间：
2017-03-28
影响因子：
8.8
通讯作者：
Dalton SO
中科院分区：
文献类型：
--
作者：
Johansen C;Schüz J;Andreasen AS;Dalton SO
神经胶质瘤是一种罕见的脑肿瘤，预后非常差，寻找可改变的因素是激烈的。我们回顾了病例对照设计的流行病学研究中有关脑胶质瘤危险因素的文献，以讨论这种方法对观察结果的影响。在回顾三种暴露（医疗辐射、外源性激素使用和过敏）之间的关系时，我们对病例对照研究和队列研究的证据进行了批判性评价。对于医学放射和激素替代疗法（HRT），基于顺铂的病例对照研究似乎显示出负相关性，而巢式病例对照和队列研究显示无相关性。对于过敏，无论研究设计如何，都观察到了负相关。我们建议，在确定神经胶质瘤等疾病的因果关系的研究中，将基于药物的病例对照设计放在较低的层次。我们建议，最先进的病例对照研究应至少伴随着对暴露评估方法的广泛验证和研究样本在相关暴露方面的代表性。否则，这样的研究不能被视为“假设检验”，而只是“假设生成”。我们认为，这适用于所有以癌症和其他慢性病为基础的病例对照研究，尽管对于每种确定性-结果组合可能程度不同。
Glioma is a rare brain tumour with a very poor prognosis and the search for modifiable factors is intense. We reviewed the literature concerning risk factors for glioma obtained in case–control designed epidemiological studies in order to discuss the influence of this methodology on the observed results. When reviewing the association between three exposures, medical radiation, exogenous hormone use and allergy, we critically appraised the evidence from both case–control and cohort studies. For medical radiation and hormone replacement therapy (HRT), questionnaire-based case–control studies appeared to show an inverse association, whereas nested case–control and cohort studies showed no association. For allergies, the inverse association was observed irrespective of study design. We recommend that the questionnaire-based case–control design be placed lower in the hierarchy of studies for establishing cause-and-effect for diseases such as glioma. We suggest that a state-of-the-art case–control study should, as a minimum, be accompanied by extensive validation of the exposure assessment methods and the representativeness of the study sample with regard to the exposures of interest. Otherwise, such studies cannot be regarded as ‘hypothesis testing' but only ‘hypothesis generating'. We consider that this holds true for all questionnaire-based case–control studies on cancer and other chronic diseases, although perhaps not to the same extent for each exposure–outcome combination.