腹股沟疝与睾丸癌关系的Meta分析

Meta-analysis on the relationship between inguinal hernia and testicular cancer

目的 探讨腹股沟疝与睾丸癌发生的关联性. 方法 计算机检索万方数据全文数据库、中国期刊全文数据库、维普中文科技期刊全文数据库、中国生物医学文献数据库、PubMed、荷兰《医学文摘》,并辅以参考文献的追溯,收集1979-2012年公开发表的关于腹股沟疝与睾丸癌发生的关联性研究论文.初筛获得相关文献49篇,其中中文文献6篇、英文文献43篇,选择比值比（OR）/标准化发生比（SIR）及其95％CI作为Meta分析指标.利用STATA 11.0软件对研究结果进行异质性检验和效应值合并计算. 结果 根据统一的纳入和剔除标准,纳入17篇文献,其中病例对照研究文献16篇,队列研究文献1篇.16篇病例对照研究文献中,睾丸癌患者4695例,对照组6328例,其中结果显示腹股沟疝与睾丸癌的发生有关联者6篇,16篇合并OR值为1.33（95％CI 1.06～1.67）,有统计学意义,有腹股沟疝者发生睾丸癌的可能性为无腹股沟疝者的1.33倍.1篇队列研究文献中腹股沟疝患者队列人数30 199例,SIR=1.1 （95％CI 0.4～2.2）,无统计学意义. 结论 腹股沟疝与睾丸癌的发生之间存在关联性,腹股沟疝增加睾丸癌的患病风险.

Objective To evaluate the associations between inguinal hernia and testicular cancer. Methods A computerized search on literature was carried out in Wanfang, CNKI, VIP databases and CBM, PubMed, EMBASE databases to collect articles published between 1979 and 2012 concerning the as- sociations between inguinal hernia and testicular cancer. There are total 49 articles, in which six articles were written in Chinese and other articles were written in English. Odds ratio （OR） and standard incidence ratio （SIR） were used to assess the strength of the association,and 95% Confidence Interval （CI） to present the precision of the estimates. Meta-analysis was performed using the STATA （11.0） statistical software. Results We identified 16 case-control studies and one cohort studies by the uniform inclusion and exclusion criteria. Among the 16 case-control studies, six reported statistically significant positive association between inguinal hernia and testicular cancer, the others reported none statistically significant association between in- guinal hernia and testicular cancer. Analysis of the 16 case-control studies that included 4695 testicular canc- er patients and 6328 controls revealed an overall statistically significant association between inguinal hernia and testicular cancer （summary OR = 1.33, 95% CI 1.06 to 1.67）. Of the one cohort study that included 30 199 inguinal hernia patients and reported SIR （1.1, 0.4-2.2）, there was not a statistically significant association between inguinal hernia and testicular cancer. Conclusions Our findings support a relationship between inguinal hernia and increased risk of testicular cancer.