糖尿病对非肌层浸润性膀胱癌预后影响的Meta分析

Prognostic Effect of Diabetes Mellitus on Non-muscle Invasive Bladder Cancer: A Meta-analysis

目的系统评价糖尿病对非肌层浸润性膀胱癌(non-muscle-invasive bladder cancer,NMIBC)患者预后的影响。方法通过计算机检索PubMed、EMBase、Web of Science、CNKI、CBM和维普数据库,收集有关糖尿病影响NMIBC患者预后的队列研究,评价糖尿病对NMIBC患者无复发生存时间(recurrence free survival,RFS)和无进展生存时间(progression free survival,PFS)的影响,检索时间从建库至2019年5月。由两名研究者独立筛选文献、提取资料并对纳入研究进行质量评价和偏倚风险评估后,采用进行Stata 15.0软件进行Meta分析。结果共纳入5篇队列研究,研究对象合计2438例,其中合并糖尿病患者443例,未合并糖尿病患者1995例。Meta分析结果显示,糖尿病增加了NMIBC患者术后的无复发生存风险(HR=1.69,95%CI:1.30~2.21,P=0.000)和无进展生存风险(HR=2.46,95%CI:1.40~4.43,P=0.002),差异均有统计学意义。敏感度分析显示本研究的稳定性较好,漏斗图提示未见明显发表偏倚。结论糖尿病可使NMIBC患者术后的肿瘤复发和进展风险升高,使患者预后不佳。建议加强NMIBC合并糖尿病患者的血糖管理,积极预防肿瘤的复发和进展。

Objective To systematically evaluate the effect of diabetes mellitus on the prognosis of patients with non-muscle invasive bladder cancer(NMIBC).Methods PubMed,EMBase,Web of Science,CNKI,CBM and VIP databases were electronically searched to collect cohort studies on the effect of diabetes on the prognosis of NMIBC patients from the establishment of the database to May 2019.The effects of diabetes on recurrence free survival(RFS)and progression free survival(PFS)of NMIBC patients were evaluated.Two reviewers independently screened literatures,extracted data and evaluated the quality and risk of bias of the included studies.The Meta-analysis was conducted with Stata 15.0 software.Results Five cohort studies with 2438 NMIBC patients were included,involving 443 cases of diabetes mellitus and 1995 cases of non-diabetes mellitus.Meta-analysis showed that diabetes increased the risk of recurrence free survival(HR=1.69,95%CI:1.30-2.21,P=0.000)and progression free survival(HR=2.46,95%CI:1.40-4.43,P=0.002)after tumor resection.There was statistically significant differences between two groups.Sensitivity analysis showed that the study was stable,and funnel plot showed no significant publication bias.Conclusion Diabetes mellitus increases the risk of recurrence and progression of NMIBC patients after tumor resection,and lead to poor prognosis.It is suggested that plasma glucose management be conducted in NMIBC patients with diabetes mellitus to prevent recurrence and progress of tumors.