Julia Reizner, Simone Fischer, Jakob Linseisen, Christa Meisinger, Dennis Freuer
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引用次数: 0
摘要
背景：越来越多的证据表明，某些自身免疫性疾病可以调节消化系统癌症的风险。然而，非实验研究的局限性可能导致结果的分歧。因此，本研究的目的是评估现有证据，并对乳糜泻（CD）、系统性红斑狼疮（SLE）、多发性硬化症（MS）和1型糖尿病（T1D）与不同消化系统癌症之间的关联提供最小偏差估计。方法：根据PRISMA指南进行系统评价（PROSPERO: CRD42024553216）。在PubMed， Web of Science， Embase和Cochrane Library中检索了从成立到2025年5月2日的科学出版物，对出版日期没有限制。ROBINS-E工具用于检查研究特异性偏倚风险。采用反方差加权随机效应模型作为主要的meta分析方法。异质性在包括多项分析的综合偏倚评估中被量化和调整。研究结果：这项研究包括了47项研究的237项估计，涵盖了任何种族的150多万例病例。CD、SLE和T1D与胰腺癌、食管癌、结肠癌、肝癌和肝胆癌呈正相关。此外，T1D与胃癌和结直肠癌呈正相关。经偏倚校正后发现，CD与小肠癌之间存在最强的相关性（RR = 4.19; 95% CI:[2.71; 6.50]）。MS与胰腺癌、食管癌、直肠癌和结直肠癌呈负相关。解释：本研究通过调整多偏倚来源，为自身免疫性疾病相关的消化系统癌症风险证据提供了新的见解。下一步，应该研究导致不同关联的潜在机制。资助：本研究获得了德国奥格斯堡大学医学院的学术资助。
Evaluating the risk of digestive system cancer in autoimmune disease patients: a systematic review and meta-analysis focusing on bias assessment.
Background: There is emerging evidence that certain autoimmune diseases can modulate the risk for digestive system cancer. However, limitations of non-experimental studies may lead to diverging results. Thus, the aim was to evaluate the available evidence and provide bias-minimized estimates for the associations between celiac disease (CD), systemic lupus erythematosus (SLE), multiple sclerosis (MS), and type 1 diabetes (T1D) and different digestive system cancers.
Methods: Systematic review (PROSPERO: CRD42024553216) was conducted according to PRISMA guidelines. Scientific publications were searched in PubMed, Web of Science, Embase, and Cochrane Library from inception up to May 2, 2025, with no restrictions on publication date. ROBINS-E tool was used for examining the study-specific risk of bias. Inverse-variance weighted random-effects models were performed as the primary meta-analytic approach. Heterogeneity was quantified and adjusted for in a comprehensive bias assessment including several analyses.
Findings: This study included 237 estimates from 47 studies covering over 1.5 million cases of any ethnicity. CD, SLE, and T1D were positively associated with pancreatic, esophageal, colon, liver, and hepatobiliary cancers. Additionally, T1D was positively associated with stomach and colorectal cancers. The strongest bias-corrected association was found between CD and small intestine cancer (RR = 4.19; 95% CI: [2.71; 6.50]). MS was inversely associated with pancreatic, esophageal, rectal, and colorectal cancers.
Interpretation: This study provides new insights into the evidence for digestive system cancer risk related to autoimmune diseases by adjusting for multiple sources of bias. As a next step, potential mechanisms responsible for the different associations should be investigated.
Funding: The study received academic funding from the Faculty of Medicine, University of Augsburg, Germany.
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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