Risk of Cancer in Inflammatory Bowel Diseases: Umbrella Review and Reanalysis of Meta-analyses

IF 25.1 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Pub Date : 2022-09-01 Epub Date: 2022-05-26 DOI:10.1053/j.gastro.2022.05.038

Daniele Piovani , Cesare Hassan , Alessandro Repici , Lorenza Rimassa , Carmelo Carlo-Stella , Georgios K. Nikolopoulos , Elio Riboli , Stefanos Bonovas

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引用次数: 11

Abstract

Background & Aims

To summarize the epidemiologic evidence and assess the validity of claimed associations of inflammatory bowel diseases (IBDs) with overall and site-specific cancer risk.

Methods

We systematically searched PubMed, Embase, and Scopus from inception to May 10, 2021, to identify and comprehensively reanalyze the data of meta-analyses on associations between IBDs (ie, Crohn’s disease [CD] and ulcerative colitis [UC]) and subsequent risk of cancer. The strength of epidemiologic evidence was graded as high, moderate, or weak, by applying prespecified criteria that included the random effects estimate, its 95% confidence interval, and P value, estimates of heterogeneity, small-study effects, and robustness to unmeasured confounding.

Results

This study critically appraised 277 estimates derived from 24 published meta-analyses and our own meta-analyses. The association between pediatric-onset IBDs and overall risk of cancer showed high epidemiologic evidence. Twenty associations (15 cancer types) demonstrated moderate evidence: any cancer (pediatric-onset UC), mouth to terminal ileum (CD), small bowel (CD/UC), colon (CD), rectum (CD/UC), colon-rectum (IBDs, pediatric-onset CD/UC), bile ducts and liver (CD/UC), liver (CD), intrahepatic cholangiocarcinoma (IBDs), bile ducts (CD), skin (CD), squamous cell carcinoma of the skin (CD), nonmelanoma skin cancer (UC), kidney (CD), and thyroid cancer (IBDs). Another 40 associations (23 cancer types) showed statistical significance; however, our confidence in these effect estimates was weak. No statistical significance was found regarding further 47 associations.

Conclusions

Associations between IBDs and different types of malignancy showed varying levels of evidence and magnitude of risk. Further primary research investigating the impact of a consistent set of risk factors that are known to affect cancer risk is warranted.

Systematic Review Registration

PROSPERO CRD42021254996.

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炎症性肠病的癌症风险:综述和meta分析的再分析

背景,目的总结流行病学证据并评估炎症性肠病(IBDs)与整体和部位特异性癌症风险相关的有效性。方法系统检索PubMed、Embase和Scopus自成立之日起至2021年5月10日，对ibd(即克罗恩病(Crohn’s disease, CD)和溃疡性结肠炎(ulative colitis, UC)与后续癌症风险相关性的meta分析数据进行识别和综合再分析。通过应用预先规定的标准，将流行病学证据的强度分为高、中、弱三个等级，这些标准包括随机效应估计、95%置信区间、P值、异质性估计、小研究效应和对未测量混杂因素的稳健性。结果:本研究对来自24项已发表的荟萃分析和我们自己的荟萃分析的277项估计进行了批判性评估。儿科发病的IBDs与癌症总体风险之间的关联显示出高度的流行病学证据。20种关联(15种癌症类型)显示了中等程度的证据:任何癌症(儿科发病的UC)，口至回肠末端(CD)，小肠(CD/UC)，结肠(CD)，直肠(CD/UC)，结肠-直肠(IBDs，儿科发病的CD/UC)，胆管和肝脏(CD/UC)，肝脏(CD)，肝内胆管癌(IBDs)，胆管(CD)，皮肤(CD)，皮肤鳞状细胞癌(CD)，非黑色素瘤皮肤癌(UC)，肾脏(CD)和甲状腺癌(IBDs)。另有40例(23种癌症类型)有统计学意义;然而，我们对这些效应估计的信心很弱。另外47种关联没有发现统计学意义。结论IBDs与不同类型恶性肿瘤的相关性显示出不同程度的证据和风险程度。有必要进行进一步的初步研究，调查一系列已知的影响癌症风险的风险因素的影响。系统评价注册号prospero CRD42021254996。

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来源期刊

Gastroenterology 医学-胃肠肝病学

CiteScore

45.60

自引率

2.40%

发文量

4366

审稿时长

26 days

期刊介绍： Gastroenterology is the most prominent journal in the field of gastrointestinal disease. It is the flagship journal of the American Gastroenterological Association and delivers authoritative coverage of clinical, translational, and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. Some regular features of Gastroenterology include original research studies by leading authorities, comprehensive reviews and perspectives on important topics in adult and pediatric gastroenterology and hepatology. The journal also includes features such as editorials, correspondence, and commentaries, as well as special sections like "Mentoring, Education and Training Corner," "Diversity, Equity and Inclusion in GI," "Gastro Digest," "Gastro Curbside Consult," and "Gastro Grand Rounds." Gastroenterology also provides digital media materials such as videos and "GI Rapid Reel" animations. It is abstracted and indexed in various databases including Scopus, Biological Abstracts, Current Contents, Embase, Nutrition Abstracts, Chemical Abstracts, Current Awareness in Biological Sciences, PubMed/Medline, and the Science Citation Index.