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Cancers (Basel):与无患癌人群对照相比,癌症患者糖尿病发病率较高

2022-04-18 从医路漫漫 MedSci原创

癌症和糖尿病可能有共同的风险因素,如年龄较大、吸烟、肥胖、不健康的饮食、缺乏体育锻炼和饮酒过量。

背景:如今,癌症被认为是全球的一个主要公共卫生问题。据估计,2020年全球约有1930万新发癌症病例被确诊。由于癌症筛查、诊断和治疗的进步以及人口老龄化,全球癌症患者(包括存活至少5年的长期癌症幸存者)的数量正在增加。

先前的研究表明,癌症患者共患糖尿病可能很常见。发现糖尿病在癌症患者中比在非癌症人群中更普遍,这可能是由于几个原因。例如,癌症和糖尿病可能有共同的风险因素,如年龄较大、吸烟、肥胖、不健康的饮食、缺乏体育锻炼和饮酒过量。糖尿病还可能增加某些类型癌症的风险,如乳腺癌和结肠直肠癌,并使肝癌、胰腺癌和子宫内膜癌的风险增加一倍。除了癌症疾病,癌症治疗如放疗、糖皮质激素、靶向治疗、造血细胞移植(HCT)和雄激素剥夺治疗(ADT)也可能导致糖尿病风险增加。

在癌症患者中,糖尿病与较差的健康相关生活质量(HRQOL)、较高的医疗保健利用率以及癌症进展和死亡率增加的风险相关,这突出了了解癌症患者是否更有可能发展为糖尿病的临床重要性。

目前,关于癌症幸存者与非癌症人群糖尿病发病率的不一致结果已被报道。几项研究证明了发展后续糖尿病和癌症之间的正相关,而其他研究没有。最近的一项系统性综述通过汇总13项基于人群的队列研究和事件发生时间结果,报告了癌症和糖尿病之间的总体正相关,但该综述不包括非基于人群的研究和没有事件发生时间数据的基于人群的研究。

目的:我们旨在通过对队列研究的结果进行系统回顾和荟萃分析,评估癌症患者中是否有较高的糖尿病发病率。

方法:利用PubMed(MEDLINE)、Embase、Web of Science和Cochrane Library数据库,对癌症患者糖尿病发病率的队列研究进行系统的电子文献检索。随机效应荟萃分析用于汇总估计值。

结果:共纳入34篇文献,涉及360971名癌症患者和1819451名无癌症对照者。与无癌症人群相比,癌症患者糖尿病的合并相对风险(RR)增加1.42 (95%可信区间(CI):1.30–1.54,I2 = 95,τ2 = 0.0551,p < 0.01)。最高的相对风险出现在癌症诊断后的第一年(RR = 2.0695%可信区间为1.63–2.60)。

表1 队列研究a采用纽卡斯尔-渥太华量表(NOS)对纳入研究进行质量评估(研究按发表年份和第一作者排序)

图1 与未患癌症的对照组相比,癌症患者患糖尿病的总体相对风险。95%的预测区间提供了癌症和糖尿病之间真实关联的预测范围

图2 灵敏度分析

图3 偏倚漏斗图

结论:新发糖尿病与癌症呈正相关,但这种相关性因癌症类型而异。提倡进行更多大样本、长时间随访的前瞻性研究,以进一步研究这种联系和潜在机制。

 

原文出处:

Yang K,  Liu Z,  Thong MSY, et al.Higher Incidence of Diabetes in Cancer Patients Compared to Cancer-Free Population Controls: A Systematic Review and Meta-Analysis.Cancers (Basel) 2022 Apr 02;14(7) .

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    2022-05-09 amyloid
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    2022-12-27 anminleiryan
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    2022-04-19 lq0307

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