文章摘要

糖尿病对膀胱切除术后患者预后影响的Meta分析

作者: 1,2简伟明, 3刘道申, 1孔雪, 1孙超, 1吴利平, 1张华
1 空军军医大学第一附属医院老年病科,西安 710032
2 联勤保障部队第909医院卫勤处,福建 漳州 363000
3 空军军医大学第一附属医院神经内科,西安 710032
通讯: 张华 Email: zhanghua77@fmmu.edu.cn
DOI: 10.3978/j.issn.2095-6959.2020.08.008
基金: 国家自然科学基金(81370928);陕西省社会发展科技攻关项目(2015SF095);空军军医大学第一附属医院学科助推计划(XJZT18ML79)。

摘要

目的:系统评价糖尿病对根治性膀胱切除(radical cystectomy,RC)术后的膀胱癌患者预后的影响。方法:通过计算机检索PubMed,Web of Science,EMBase,Cochrane Library,中国生物医学文献数据库(CBM),中国知网(CNKI)和万方(WANFANG)数据库,收集有关糖尿病对RC术后膀胱癌患者预后影响的队列研究,评价糖尿病对患者总体死亡风险(overall mortality,OM)和肿瘤特异死亡风险(cancer specific mortality,CSM)的影响,检索时间从建库至2019年9月。由两名研究者按照纳入与排除标准分别独立进行文献筛选,对纳入研究进行质量评价并提取数据,采用Stata 15.0软件进行Meta分析。结果:共纳入5项队列研究,研究对象合计2 661例,其中糖尿病组391例,非糖尿病组2 270例。Meta分析结果显示:糖尿病增加了RC术后患者的总体死亡风险(HR=1.38,95%CI:1.21~1.57,P<0.001)和肿瘤特异死亡风险(HR=1.69,95%CI:1.36~2.10,P<0.001),差异均有统计学意义。敏感性分析显示本研究的稳定性较好,采用剪补法进行发表偏倚分析提示虽然可能存在一定发表偏倚,但不影响Meta分析结果的稳定性。结论:糖尿病可使膀胱癌患者RC术后的死亡风险升高,使患者预后不佳。
关键词: 糖尿病;膀胱癌;根治性膀胱切除术;预后;Meta分析

Effect of diabetes mellitus on prognosis of patients after radical cystectomy: a Meta-analysis

Authors: 1,2JIAN Weiming, 3LIU Daoshen, 1KONG Xue, 1SUN Chao, 1WU Liping, 1ZHANG Hua
1 Department of Geriatrics, First Affiliated Hospital of the Air Force Military Medical University, Xi’an 710032, China
2 Department of Medical Service, No. 909 Hospital, Joint Logistics Support Force, Zhangzhou Fujian 363000, China
3 Department of Neurology, First Affiliated Hospital of the Air Force Military Medical University, Xi’an 710032, China

CorrespondingAuthor: ZHANG Hua Email: zhanghua77@fmmu.edu.cn

DOI: 10.3978/j.issn.2095-6959.2020.08.008

Foundation: This work was supported by the National Natural Science Foundation (81370928), Science and Technology Research Program for Social Development of Shaanxi Province (2015SF095) and Discipline Promotion Program of the First Affiliated Hospital of Air Force Military Medical University (XJZT18ML79), China.

Abstract

Objective: To systematically evaluate the effect of diabetes mellitus on the prognosis of patients with bladder cancer after radical cystectomy. Methods: PubMed, Web of Science, EMBase, Cochrane Library, CBM, CNKI and WANFANG databases were searched by computer to collect cohort studies on the effect of diabetes on the prognosis of patients with bladder cancer after radical cystectomy from the establishment of the database to September 2019. The effects of diabetes on overall mortality (OM) and cancer specific mortality (CSM) were evaluated. Two researchers independently screened literatures, evaluated the quality of the included studies and extracted the data. Meta-analysis was conducted with Stata 15.0 software. Results: A total of 5 cohort studies were included with 2 661 bladder cancer patients, involving 391 cases of diabetes mellitus and 2 270 cases of non-diabetes mellitus. Meta-analysis showed that diabetes increased the risk of overall mortality (HR =1.38, 95% CI: 1.21–1.57, P<0.001) and cancer specific mortality (HR=1.69, 95% CI: 1.36–2.10, P<0.001) after radical cystectomy. Sensitivity analysis showed that the stability of this study was good. Publication bias analysis using trim-and-fill method suggested that although there might be some publication bias, it did not affect the results of this meta-analysis. Conclusion: Diabetes mellitus can increase the risk of death in patients with bladder cancer after radical cystectomy, and lead to poor prognosis.
Keywords: diabetes mellitus; bladder cancer; radical cystectomy; prognosis; Meta-analysis