Diabetes mellitus as an independent risk factor for lung cancer: A meta-analysis of observational studies
Diabetes mellitus as an independent risk factor for lung cancer: A meta-analysis of observational studies
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DOI：
10.1016/j.ejca.2013.02.025
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发表时间：
2013-07-01
影响因子：
8.4
通讯作者：
Park, Sang Min
中科院分区：
文献类型：
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作者：
Lee, Jung-Yun;Jeon, Inpyo;Park, Sang Min
背景：流行病学研究表明糖尿病与肺癌风险之间的关系不一致。为了确定糖尿病是否与肺癌的风险增加，我们进行了荟萃分析observational studies.Methods：PubMed，EMBASE和科克伦图书馆进行了搜索2012年9月之前进行的观察性研究。我们纳入了报告相对风险的前瞻性队列研究和显示优势比的病例对照研究。采用随机效应模型计算合并相对风险（RR）和95%置信区间（CI）。敏感性分析与控制吸烟状态的研究进行。协会进行了评估，在几个亚组代表不同的参与者和研究characteristics.Results：共34项研究，从24个手稿（10个病例对照研究和24个队列研究）被纳入分析。与非糖尿病对照组相比，糖尿病与肺癌风险增加显著相关（RR，1.11; 95%CI，1.02-1.20; I-2 = 46.1%）。相比之下，当分析仅限于未调整吸烟状况的研究时，这种关联消失（RR，0.99; 95%CI，0.88-1.11; I-2 = 96.7%）。当按性别分层时，糖尿病女性中肺癌风险增加显著（RR，1.14; 95%CI，1.09-1.20; I-2 = 0%），而糖尿病男性中无相关性（RR，1.07; 95%CI，0.89-1.28; I-2 = 96.6%）。在糖尿病女性中，发现以下亚组的肺癌风险显著增加：队列研究（RR，1.14; 95% CI，1.08-1.20; I-2 = 0%），控制主要混杂变量（如年龄、吸烟和饮酒）的研究（RR，1.19; 95% CI，1.00-1.43; I-2 = 23.1%），长期随访研究（RR，1.14; 95% CI，1.08-1.20; I-2 = 0%），以及通过Newcastle-Ottawa量表评估的高质量研究（RR，1.14; 95%CI，1.08-1.20; I-2 = 0%）。解释：既往糖尿病可能增加肺癌的风险，尤其是女性糖尿病患者。需要进一步的大规模前瞻性研究来专门测试糖尿病对肺癌风险的影响。(c)2013爱思唯尔有限公司保留所有权利。
Background: Epidemiologic studies have demonstrated inconsistent associations between diabetes mellitus and the risk of lung cancer. To determine whether diabetes mellitus is associated with an increased risk of lung cancer, we performed a meta-analysis of observational studies.Methods: PubMed, EMBASE and the Cochrane Library were searched for observational studies conducted prior to September 2012. We included prospective cohort studies that reported relative risks and case-control studies that showed odds ratios in the analysis. The pooled relative risk (RR) with 95% confidence intervals (CIs) was calculated with a random effects model. Sensitivity analysis was performed with studies which controlled for smoking status. Associations were assessed in several subgroups representing different participant and study characteristics.Results: A total of 34 studies from 24 manuscripts (10 case-control studies and 24 cohort studies) were included in the analyses. Diabetes was significantly associated with the increased risk of lung cancer compared with non-diabetic controls when limiting the analysis to studies adjusting for smoking status (RR, 1.11; 95% CI, 1.02-1.20; I-2 = 46.1%). By contrast, this association disappeared when the analysis was restricted to studies not adjusting for smoking status (RR, 0.99; 95% CI, 0.88-1.11; I-2 = 96.7%). When stratifying by sex, an increased risk of lung cancer was prominent in diabetic women (RR, 1.14; 95% CI, 1.09-1.20; I-2 = 0%), while there was no association in diabetic men (RR, 1.07; 95% CI, 0.89-1.28; I-2 = 96.6%). Among diabetic women, significantly increased risks of lung cancer were found in the following subgroups: cohort studies (RR, 1.14; 95% CI, 1.08-1.20; I-2 = 0%), studies controlling for major confounding variables such as age, smoking and alcohol (RR, 1.19; 95% CI, 1.00-1.43; I-2 = 23.1%), studies with long-term follow-up (RR, 1.14; 95% CI, 1.08-1.20; I-2 = 0%), and high-quality studies assessed by the Newcastle-Ottawa Scale (RR, 1.14; 95% CI, 1.08-1.20; I-2 = 0%).Interpretation: Preexisting diabetes mellitus may increase the risk of lung cancer, especially among female diabetic patients. Further large-scale prospective studies are needed to test specifically the effect of diabetes mellitus on lung cancer risk. (c) 2013 Elsevier Ltd. All rights reserved.