超重、肥胖和卵巢癌关联的meta分析
发布时间：2019-06-26 23:37
【摘要】：目的:卵巢癌是继子宫内膜癌和宫颈癌发病率居第三位的妇科恶性肿瘤,对妇女的健康构成了严重的威胁。由于卵巢癌发病隐匿,早期缺乏典型的症状,导致大多数卵巢癌患者确诊时已为晚期,治疗效果和预后极差,其死亡率居妇科肿瘤之首。尽管诸如年龄、家族史等卵巢癌发病的危险因素已经得到公认,但是卵巢癌的发病原因还没有完全被阐释清楚。因为对卵巢癌还没有成熟有效的普查手段,所以能够识别其危险因素就显得尤为重要。有研究表明,超重和肥胖也可能是卵巢癌的危险因素之一,但是目前不同的流行病学研究间的结论并不一致。而且,超重,肥胖与卵巢癌的关联是否会受绝经与否的影响,现在争议还很大。为了更新现有的知识,并进一步探讨超重、肥胖与卵巢癌的关联,以及二者的关联是否会受不同绝经状况的影响,本研究对已发表的观察性研究进行了meta分析。方法:1文献搜集及检索策略。检索数据库PubMed,EMBASE和中国生物医学文献数据库(CBM)、相关期刊论文(CNKI)、维普期刊数据库(VIP),万方数据库上于2016年12月以前已发表的关于超重、肥胖与卵巢癌关联的文献。英文检索词为(“BMI”or“body mass index”or“overweight”or“obesity”)and(“ovarian cancer”or“ovarian neoplasm”or“ovarian carcinoma”),中文检索词为“体质指数”或“超重、肥胖”和“卵巢癌”。相关文章的参考文献也进行了查阅来搜检文献。2文献的纳入与排除标准。文献符合以下条件被纳入:1)研究设计为观察性研究(队列研究或病例对照研究);2)探讨超重、肥胖与卵巢癌的关联,并且以体质指数(BMI)来明确地定义超重和肥胖;3)文章提供了相应的风险效应值。两名研究者独立评估合格的已纳入文献。如遇分歧通过讨论解决。排除标准:1)综述或系统评价以及meta分析;2)无法获得风险效应值;3)重复的数据;4)摘要和未发表的报道。3纳入文献的质量评价。对预纳入的文献运用九分newcastle-ottawascale(nos)量表进行评价,文献评分若大于等于六颗星,则可认为是高质量研究可以被纳入。4提取数据。每篇文献中提取如下信息:第一作者姓名,文章发表年份,原始国别,研究的时间,研究的名称,暴露的测量,研究人群的年龄和数目,病例和对照人群的来源,病例的绝经情况以及肥胖与oc关联的风险效应值。5统计学分析。采用stata12.0(statacorp,collegestation,tx,usa)软件进行数据分析。用合并rr值和95%可信区间(ci)评估所有研究中超重、肥胖与卵巢癌的关联强度。q检验统计量和i2测量值来检验和量化纳入文献的异质性,并且按照文章发表年份进行累积meta分析,观察肥胖和卵巢癌关联随时间推移的变化趋势。egger’s检验和begg’s检验评估漏斗图的对称性来评价潜在的发表偏倚。进行敏感性分析来验证结果的稳定性。结果:1文献搜索结果:经过初步筛选共获得70篇文献,使用上述检索策略,排除41篇不合格文献,最终有29篇文献被纳入。其中,16篇为队列研究,13篇为病例对照研究。2文献的质量评价结果:对预纳入的29篇研究均进行了质量评价,结果显示,文献评分均大于等于六颗星,所有研究都可以被纳入。3超重、肥胖和卵巢癌关联的结果:与正常体重组(bmi=18.5 24.9kg/m2)相比较,超重组和oc发生的风险之间有统计学差异(rr=1.07,95%ci:1.03 1.12),涉及到28篇文献;同样,与正常体重组(bmi=18.5 24.9kg/m2)相比较,肥胖组和oc发生的风险之间也具有统计学差异(rr=1.27,95%ci:1.15 1.40),涉及到27篇文献。累积meta分析结果显示,不论是体重超重组还是肥胖组,关联的趋势趋于稳定,风险效应值的可信区间不断缩小。4不同亚组的分析结果:不论是队列研究还是病例对照研究,自我报告的研究还是测量的研究,体重增加均可以增加oc发生的风险,合并效应值具有统计学意义。按照研究地点分层:在体重为超重时,美洲的研究(rr=1.05,95%ci:0.96 1.41)和欧洲的研究(rr=1.05,0.99 1.11),增加的体重与OC发生风险的关联,均无统计学意义。但亚洲的研究(RR=1.05,95%CI:0.96 1.41)和大洋洲的研究(RR=1.05,95%CI:0.96 1.41),增加的体重与OC发生风险的关联,均有统计学意义;在体重为肥胖时,结果与超重相反,美洲的研究(RR=1.32,95%CI:1.20 1.45)和欧洲的研究(RR=1.21,1.05 1.40),增加的体重与OC发生风险的关联,均有统计学意义。但亚洲的研究(RR=1.23,95%CI:0.52 2.90)和大洋洲的研究(RR=1.22,95%CI:0.52 2.86),增加的体重与OC发生风险的关联,均无统计学意义。当按照绝经状况分层:在体重为超重时,不论是绝经前(RR=1.16,95%CI:0.95 1.41)还是绝经后(RR=1.01,0.90 1.14),增加的体重与OC发生风险的关联,均无统计学意义。但在体重为肥胖时,风险仅在绝经前的女性中有统计学意义(RR=1.38,95%CI:1.10 1.72),在绝经后女性中却没有统计学意义(RR=0.97,95%CI:0.73 1.29)。5发表偏倚和敏感性分析的结果:分别用Egger’s检验和Begg’s检验两种方法对“超重”组和“肥胖”组应用进行检验,Egger’s检验结果为(P=0.198和0.179),Begg’s检验结果为(P=0.650和0.404),P值均0.05,故认为不存在明显的发表偏倚。删除掉任何一篇纳入的文献,剩余文献的合并RR值没有明显的变化,验证了结果的稳健性。结论:过分增长的体重会增加卵巢癌的发生风险,而且肥胖程度严重的女性表现出更强的风险效果。但是,这种风险仅在绝经前的女性中有统计学意义,在绝经后女性中却没有统计学意义。
[Abstract]:Objective: Ovarian cancer is the third gynecologic malignant tumor following the incidence of endometrial carcinoma and cervical cancer, which poses a serious threat to the health of women. Due to the insidious and early absence of typical symptoms in the patients with ovarian cancer, most of the patients with ovarian cancer have been diagnosed with a late stage, a poor treatment and a poor prognosis, and the mortality rate is the first in the gynecological tumors. Although the risk factors such as age, family history and other ovarian cancer have been recognized, the cause of ovarian cancer is not fully explained. Because there is no mature and effective means of screening for ovarian cancer, it is particularly important to be able to identify its risk factors. Studies have shown that overweight and obesity may also be one of the risk factors for ovarian cancer, but the conclusions of the current epidemiological studies are not consistent. Also, whether the association of overweight, obesity and ovarian cancer is affected by the menopause is still large. In order to update the existing knowledge and to further explore the association between overweight, obesity and ovarian cancer, and whether their association is affected by different menopausal conditions, this study has made a meta-analysis of the published observational studies. Methods:1 Literature collection and retrieval strategy. The search database PubMed, EMBASE and the Chinese Biomedical Literature Database (CBM), the Chinese Journal Full-text Database (CNKI), the Vip Journal Database (VIP), and the Wanfang database, published in December 2016, have been published on the association of overweight, obesity and ovarian cancer. The Chinese search term is" body mass index "or overweight, obesity" and "ovarian cancer". References of the related articles have also been reviewed for the search of the literature. The inclusion and exclusion criteria of the literature. The literature was included in the following conditions:1) the study was designed as an observational study (cohort study or case-controlled study);2) to investigate the association of overweight, obesity with ovarian cancer, and to clearly define overweight and obesity with a body mass index (BMI); 3) The article provides the corresponding risk effect value. Two of the investigator's independent assessments were included in the literature. If the differences are resolved through discussion. Exclusion criteria:1) review or system evaluation and meta-analysis;2) no risk-effect value;3) duplicate data;4) summary and unpublished reports.3-quality evaluation of the literature. The pre-included literature was evaluated using a nine-point newcastle-bottom-bottom (nos) scale and the literature score, if greater than or equal to six, can be considered to be a high-quality study that can be included in.4 to extract data. The following information was extracted in each document: the first author's name, the year of publication, the original country, the time of the study, the name of the study, the measurement of the exposure, the age and number of the study population, the case and the source of the control population, Postmenopausal status of the case and the value of the risk effects associated with the obesity and the c.5 statistical analysis. Data analysis was performed using the stata12.0 (statacorp, collegation, tx, usa) software. The association between overweight, obesity and ovarian cancer in all studies was assessed with the combined rr value and the 95% confidence interval (ci). Q-test statistics and i2-measured values were used to test and quantify the heterogeneity of the inclusion in the literature, and the cumulative meta-analysis was performed in the year published to observe the trend of the association of obesity and ovarian cancer over time. The egger's test and the begg's test evaluate the symmetry of the funnel diagram to evaluate potential published bias. Sensitivity analysis was performed to verify the stability of the results. Results:1 Literature search results:70 articles were obtained through preliminary screening,41 non-conforming articles were excluded by using the above-mentioned search strategy, and 29 articles were included. Of these,16 were cohort studies and 13 were case-control studies. The results of the quality evaluation of the literature: The evaluation of the quality of the pre-included 29 studies results in a literature score of greater than or equal to six stars, all of which could be included in.3 Overweight, The correlation between obesity and ovarian cancer: There was a statistically significant difference between the risk of superrecombination and the oc (r = 1.07,95% ci: 1.03.12) compared to normal body recombination (bmi = 18.5 24.9 kg/ m2), involving 28 articles; similarly, compared to normal body recombination (bmi = 18.5 24.9 kg/ m2), There was also a statistical difference between the risk between the obesity group and the oc (r = 1.27,95% ci: 1.15 1.40), involving 27 articles. The cumulative meta-analysis showed that the correlation trend was stable and the confidence interval of the risk-effect value decreased continuously, both in the body weight and in the obese group. The results of the analysis in the different subgroups: whether the cohort study was a case-controlled study, the self-reported study or the measurement, Weight gain can increase the risk of oc occurrence and the combined effect value is of statistical significance. Stratification according to the study site: when the body weight was overweight, studies in the Americas (rr = 1.05,95% ci: 0.96 1.41) and European studies (rr = 1.05, 0.99.11), increased body weight and the risk of OC occurrence were not statistically significant. However, studies in Asia (RR = 1.05,95% CI: 0.96 1.41) and Oceania (RR = 1.05,95% CI: 0.96 1.41), increased body weight and the risk of OC occurrence were statistically significant; in the case of obesity, the results were in contrast to overweight, in the Americas (RR = 1.32,95% CI: 1.20 1.45) and in Europe (RR = 1.21, 1.05. 1.40), The increased body weight was associated with the risk of OC occurrence, all of which were statistically significant. However, studies in Asia (RR = 1.23,95% CI: 0.52 2.90) and Oceania (RR = 1.22,95% CI: 0.52 2.86), increased body weight and the risk of OC occurrence were not statistically significant. The increased body weight was not statistically significant when the body weight was overweight, either before or after menopause (RR = 1.16,95% CI: 0.95 1.41) or after menopause (RR = 1.01, 0.90.14). However, in the case of obesity, the risk was only statistically significant in pre-menopausal women (RR = 1.38,95% CI: 1.10 1.72), with no statistical significance in postmenopausal women (RR = 0.97,95% CI: 0.73 1.29). The results of Egger's test were (P = 0.198 and 0.179). The results of the test were (P = 0.198 and 0.179), and the results of the Beg's test were (P = 0.650 and 0.404). There was no significant change in the combined RR values of the remaining literature, and the robustness of the results was verified. Conclusion: The excessive increase of body weight will increase the risk of ovarian cancer, and the most obese women show a stronger risk. However, this risk is only statistically significant in pre-menopausal women, but there is no statistical significance in postmenopausal women.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31;R589.2
本文编号：2506595
[Abstract]:Objective: Ovarian cancer is the third gynecologic malignant tumor following the incidence of endometrial carcinoma and cervical cancer, which poses a serious threat to the health of women. Due to the insidious and early absence of typical symptoms in the patients with ovarian cancer, most of the patients with ovarian cancer have been diagnosed with a late stage, a poor treatment and a poor prognosis, and the mortality rate is the first in the gynecological tumors. Although the risk factors such as age, family history and other ovarian cancer have been recognized, the cause of ovarian cancer is not fully explained. Because there is no mature and effective means of screening for ovarian cancer, it is particularly important to be able to identify its risk factors. Studies have shown that overweight and obesity may also be one of the risk factors for ovarian cancer, but the conclusions of the current epidemiological studies are not consistent. Also, whether the association of overweight, obesity and ovarian cancer is affected by the menopause is still large. In order to update the existing knowledge and to further explore the association between overweight, obesity and ovarian cancer, and whether their association is affected by different menopausal conditions, this study has made a meta-analysis of the published observational studies. Methods:1 Literature collection and retrieval strategy. The search database PubMed, EMBASE and the Chinese Biomedical Literature Database (CBM), the Chinese Journal Full-text Database (CNKI), the Vip Journal Database (VIP), and the Wanfang database, published in December 2016, have been published on the association of overweight, obesity and ovarian cancer. The Chinese search term is" body mass index "or overweight, obesity" and "ovarian cancer". References of the related articles have also been reviewed for the search of the literature. The inclusion and exclusion criteria of the literature. The literature was included in the following conditions:1) the study was designed as an observational study (cohort study or case-controlled study);2) to investigate the association of overweight, obesity with ovarian cancer, and to clearly define overweight and obesity with a body mass index (BMI); 3) The article provides the corresponding risk effect value. Two of the investigator's independent assessments were included in the literature. If the differences are resolved through discussion. Exclusion criteria:1) review or system evaluation and meta-analysis;2) no risk-effect value;3) duplicate data;4) summary and unpublished reports.3-quality evaluation of the literature. The pre-included literature was evaluated using a nine-point newcastle-bottom-bottom (nos) scale and the literature score, if greater than or equal to six, can be considered to be a high-quality study that can be included in.4 to extract data. The following information was extracted in each document: the first author's name, the year of publication, the original country, the time of the study, the name of the study, the measurement of the exposure, the age and number of the study population, the case and the source of the control population, Postmenopausal status of the case and the value of the risk effects associated with the obesity and the c.5 statistical analysis. Data analysis was performed using the stata12.0 (statacorp, collegation, tx, usa) software. The association between overweight, obesity and ovarian cancer in all studies was assessed with the combined rr value and the 95% confidence interval (ci). Q-test statistics and i2-measured values were used to test and quantify the heterogeneity of the inclusion in the literature, and the cumulative meta-analysis was performed in the year published to observe the trend of the association of obesity and ovarian cancer over time. The egger's test and the begg's test evaluate the symmetry of the funnel diagram to evaluate potential published bias. Sensitivity analysis was performed to verify the stability of the results. Results:1 Literature search results:70 articles were obtained through preliminary screening,41 non-conforming articles were excluded by using the above-mentioned search strategy, and 29 articles were included. Of these,16 were cohort studies and 13 were case-control studies. The results of the quality evaluation of the literature: The evaluation of the quality of the pre-included 29 studies results in a literature score of greater than or equal to six stars, all of which could be included in.3 Overweight, The correlation between obesity and ovarian cancer: There was a statistically significant difference between the risk of superrecombination and the oc (r = 1.07,95% ci: 1.03.12) compared to normal body recombination (bmi = 18.5 24.9 kg/ m2), involving 28 articles; similarly, compared to normal body recombination (bmi = 18.5 24.9 kg/ m2), There was also a statistical difference between the risk between the obesity group and the oc (r = 1.27,95% ci: 1.15 1.40), involving 27 articles. The cumulative meta-analysis showed that the correlation trend was stable and the confidence interval of the risk-effect value decreased continuously, both in the body weight and in the obese group. The results of the analysis in the different subgroups: whether the cohort study was a case-controlled study, the self-reported study or the measurement, Weight gain can increase the risk of oc occurrence and the combined effect value is of statistical significance. Stratification according to the study site: when the body weight was overweight, studies in the Americas (rr = 1.05,95% ci: 0.96 1.41) and European studies (rr = 1.05, 0.99.11), increased body weight and the risk of OC occurrence were not statistically significant. However, studies in Asia (RR = 1.05,95% CI: 0.96 1.41) and Oceania (RR = 1.05,95% CI: 0.96 1.41), increased body weight and the risk of OC occurrence were statistically significant; in the case of obesity, the results were in contrast to overweight, in the Americas (RR = 1.32,95% CI: 1.20 1.45) and in Europe (RR = 1.21, 1.05. 1.40), The increased body weight was associated with the risk of OC occurrence, all of which were statistically significant. However, studies in Asia (RR = 1.23,95% CI: 0.52 2.90) and Oceania (RR = 1.22,95% CI: 0.52 2.86), increased body weight and the risk of OC occurrence were not statistically significant. The increased body weight was not statistically significant when the body weight was overweight, either before or after menopause (RR = 1.16,95% CI: 0.95 1.41) or after menopause (RR = 1.01, 0.90.14). However, in the case of obesity, the risk was only statistically significant in pre-menopausal women (RR = 1.38,95% CI: 1.10 1.72), with no statistical significance in postmenopausal women (RR = 0.97,95% CI: 0.73 1.29). The results of Egger's test were (P = 0.198 and 0.179). The results of the test were (P = 0.198 and 0.179), and the results of the Beg's test were (P = 0.650 and 0.404). There was no significant change in the combined RR values of the remaining literature, and the robustness of the results was verified. Conclusion: The excessive increase of body weight will increase the risk of ovarian cancer, and the most obese women show a stronger risk. However, this risk is only statistically significant in pre-menopausal women, but there is no statistical significance in postmenopausal women.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31;R589.2
【参考文献】
相关期刊论文 前1条
1 徐赫男;;从中国居民营养与慢性病状况报告看到了什么[J];糖尿病天地(临床);2016年04期
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