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Peng TR, Yang LJ, Wu TW, Chao YC. Hypnotics and Risk of Cancer: A Meta-Analysis of Observational Studies. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E513. [PMID: 33019585 PMCID: PMC7601941 DOI: 10.3390/medicina56100513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: The association between hypnotic drugs and risk of cancer remains controversial. Therefore, we performed a meta-analysis to investigate this association. Materials and Methods: Pubmed and Embase were searched systematically to identify publications up to April 2020. The Newcastle-Ottawa scale for observational studies was used to assess the quality of studies. All included studies were evaluated by two reviewers independently; any discrepancies were resolved through discussion. Results: Twenty-eight studies including 22 case-control studies and 6 cohort studies with 340,614 hypnotics users and 1,828,057 non-users were included in the final analyses. Hypnotics (benzodiazepines and Z-drugs) use was significantly associated with an increased risk of cancer (odds ratio [OR] or relative risk [RR] 1.17; 95% confidence interval 1.09-1.26) in a random-effects meta-analysis of all studies. Subgroup meta-analysis by anxiolytics/sedatives effect (anxiolytics benzodiazepines vs. sedatives group (include sedatives benzodiazepines and Z-drugs)) revealed that a significant association in sedatives group (pooled OR/RR 1.26, 95% CI, 1.10-1.45), whereas no significant relationship was observed in anxiolytics benzodiazepines (pooled OR/RR 1.09, 95% CI, 0.95-1.26). Moreover, a significant dose-response relationship was observed between the use of hypnotics and the risk of cancer. Conclusions: This meta-analysis revealed association between use of hypnotics drugs and risk of cancer. However, the use of lower dose hypnotics and shorter duration exposed to hypnotics seemed to be not associated with an increased risk of cancer. Moreover, the use of anxiolytics effect benzodiazepines seemed to be lower risk than sedatives benzodiazepines. A high heterogeneity was observed among identified studies, and results were inconsistent in some subgroups. Randomized control trials are needed to confirm the findings in the future.
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Affiliation(s)
- Tzu-Rong Peng
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (T.-R.P.); (L.-J.Y.); (T.-W.W.)
| | - Li-Jou Yang
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (T.-R.P.); (L.-J.Y.); (T.-W.W.)
| | - Ta-Wei Wu
- Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan; (T.-R.P.); (L.-J.Y.); (T.-W.W.)
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei City 11031, Taiwan
| | - You-Chen Chao
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
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Pommergaard HC, Rostved AA, Adam R, Rasmussen A, Salizzoni M, Bravo MAG, Cherqui D, De Simone P, Houssel-Debry P, Mazzaferro V, Soubrane O, García-Valdecasas JC, Prous JF, Pinna AD, O'Grady J, Karam V, Duvoux C, Thygesen LC. Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry. Liver Cancer 2020; 9:455-467. [PMID: 32999871 PMCID: PMC7506266 DOI: 10.1159/000507397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/17/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. METHODS We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. RESULTS We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23-1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99-1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21-3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31-2.00). CONCLUSIONS Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
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Affiliation(s)
- Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,*Hans-Christian Pommergaard, Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK–2100 Copenhagen (Denmark),
| | - Andreas Arendtsen Rostved
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - René Adam
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Allan Rasmussen
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Mauro Salizzoni
- Liver Transplant Centre and General Surgery, A.O.U. Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | | | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation Unit, University of Pisa Medical School Hospital, Pisa, Italy
| | - Pauline Houssel-Debry
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Université de Rennes 1, and INSERM, UMR991, Foie, Métabolisme et Cancer, Université de Rennes 1, Rennes, France
| | - Vincenzo Mazzaferro
- University of Milan and Division of Gastrointestinal Surgery and Liver Transplantation, Istituto Nazionale Tumori, Fondazione IRCCS, Milan, Italy
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplant, Beaujon Hospital, Clichy, University Denis Diderot, Paris, France
| | | | - Joan Fabregat Prous
- Unitat de Cirurgia Hepato-bilio-pancreàtica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Antonio D. Pinna
- General Surgery and Transplant Division, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Vincent Karam
- Department of Hepatobiliary Surgery, Cancer, and Transplantation, AP-HP, Hôpital Universitaire Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris Est University, Créteil, France
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Hu P, Fan L, Ding P, He YH, Xie C, Niu Z, Tian FY, Yuan S, Jia D, Chen WQ. Association between prenatal exposure to cooking oil fumes and full-term low birth weight is mediated by placental weight. ENVIRONMENTAL RESEARCH 2018; 167:622-631. [PMID: 30172195 DOI: 10.1016/j.envres.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Evidence regarding the association between prenatal exposure to cooking oil fumes (COF) and full-term low birth weight (FTLBW) is still controversial, and the mechanism remains unclear. This study thus aims to explore the association of prenatal COF exposure with off-spring FT-LBW as well as the mediating role of placenta in their association. METHODS A case-control study enrolling 266 pregnant women delivering FTLBW newborns (cases) and 1420 delivering normal birth weight (NBW) newborns (controls) was conducted. Information on prenatal COF exposure, socio-demographics, and obstetric conditions were collected at the Women's and Children's Hospitals of Shenzhen and Foshan in Guangdong, China. Linear and hierarchical logistic regression models were undertaken to explore the associations among COF exposure, placenta and birth weight, as well as the mediation effect of placental weight. RESULTS After controlling for potential confounders, prenatal COF exposure was significantly associated with the higher risk of FT-LBW (OR = 1.31, 95% CI= 1.06-1.63) and the lower placental weight (ß = -0.12, 95% CI= -0.23 ~ -0.005). Compared with mothers who never cooked, those cooking sometimes (OR= 2.99, 95% CI= 1.48-6.04) or often (OR= 3.41, 95% CI= 1.40-8.34) showed a higher risk of FT-LBW, and likewise, those cooking for less than half an hour (OR= 2.08, 95% CI= 1.14-3.79) or cooking between half to an hour (OR= 2.48, 95% CI= 1.44-4.29) were also more likely to exhibit FT-LBW. Different cooking methods including pan-frying (OR= 2.24, 95% CI= 1.30-3.85) or deep-frying (OR= 1.78, 95% CI= 1.12-2.85) during pregnancy were associated with increased FT-LBW risks as well. The further mediation analysis illustrated that placental weight mediated 15.96% (95% CI: 12.81~28.80%) and 15.90% (95% CI= 14.62%~16.66%) of the associations of cooking during pregnancy and frequency of prenatal COF exposure, respectively, with FT-LBW.
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Affiliation(s)
- Pian Hu
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Lijun Fan
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Peng Ding
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Yan-Hui He
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Chuanbo Xie
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Zhongzheng Niu
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Fu-Ying Tian
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China
| | - Shixin Yuan
- Shenzhen Women's and Children's Hospital, Shenzhen, China
| | - Deqin Jia
- Foshan Women's and Children's Hospital, Foshan, China
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, Guangzhou Key Laboratory of Environmental Pollution and Health Assessment,Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-Sen University, Guangzhou,China; Department of Information Management, Xinhua College, Sun Yat-Sen University, Guangzhou, China.
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Zhang T, Yang X, Zhou J, Liu P, Wang H, Li A, Zhou Y. Benzodiazepine drug use and cancer risk: a dose-response meta analysis of prospective cohort studies. Oncotarget 2017; 8:102381-102391. [PMID: 29254253 PMCID: PMC5731963 DOI: 10.18632/oncotarget.22057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/21/2017] [Indexed: 12/20/2022] Open
Abstract
Conflicting results identifying the relationship between benzodiazepine drug use and cancer risk. Therefore, we conducted a dose-response meta-analysis of prospective cohort studies to clarify and quantitative assessed the relationship between benzodiazepine drug use and cancer risk. Up to July 2017, 22 original publications were included in current meta-analysis. Our results showed statistically significant association between benzodiazepine drug use and cancer risk (RR:1.25; 95% CI, 1.15–1.36). Subgroup analysis showed benzodiazepine using was associated with significantly a higher risk of breast cancer (RR:1.15; 95% CI, 1.05–1.26), ovarian cancer (RR:1.17; 95% CI, 1.09–1.25), colon cancer (RR:1.07; 95% CI, 1.02–1.13), renal cancer (RR:1.31; 95% CI, 1.15–1.49), malignant melanoma (RR:1.10; 95% CI, 1.03–1.17), brain cancer (RR:2.06; 95% CI, 1.76–2.43), esophagus cancer (RR:1.55; 95% CI, 1.30–1.85), prostate cancer (RR:1.26; 95% CI, 1.16–1.37), liver cancer (RR:1.22; 95% CI, 1.13–1.31), stomach cancer (RR:1.17; 95% CI, 1.03–1.32), pancreatic cancer (RR:1.39; 95% CI, 1.17–1.64) and lung cancer (RR:1.20; 95% CI, 1.12–1.28). Furthermore, a significant dose-response relationship was observed between benzodiazepine drug use and cancer risk (likelihood ratio test, P < 0.001). Our results showed per 500 mg/year, per 5 year of time since first using, per 3 prescriptions and per 3 year of duration incremental increase in benzodiazepine drug use was associated with a 17%, 4%, 16% and 5% in cancer risk increment. Considering these promising results, increasing benzodiazepine using might be harmful for health.
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Affiliation(s)
- Tao Zhang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Xiaowen Yang
- Department of Clinical Laboratory, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Jianrui Zhou
- Department of Rehabilitation Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Pei Liu
- Department of Dermatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Hui Wang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Anrong Li
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
| | - Yi Zhou
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, 442000, China
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Thygesen LC, Pottegård A, Ersbøll AK, Friis S, Stürmer T, Hallas J. External adjustment of unmeasured confounders in a case-control study of benzodiazepine use and cancer risk. Br J Clin Pharmacol 2017; 83:2517-2527. [PMID: 28599067 DOI: 10.1111/bcp.13342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/18/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022] Open
Abstract
AIMS Previous studies have reported diverging results on the association between benzodiazepine use and cancer risk. METHODS We investigated this association in a matched case-control study including incident cancer cases during 2002-2009 in the Danish Cancer Registry (n = 94 923) and age- and sex-matched (1:8) population controls (n = 759 334). Long-term benzodiazepine use was defined as ≥500 defined daily doses 1-5 years prior to the index date. We implemented propensity score (PS) calibration using external information on confounders available from a survey of the Danish population. Two PSs were used: The error-prone PS using register-based confounders and the calibrated PS based on both register- and survey-based confounders, retrieved from the Health Interview Survey. RESULTS Register-based data showed that cancer cases had more diagnoses, higher comorbidity score and more co-medication then population controls. Survey-based data showed lower self-rated health, more self-reported diseases, and more smokers as well as subjects with sedentary lifestyle among benzodiazepine users. By PS calibration, the odds ratio for cancer overall associated with benzodiazepine use decreased from 1.16 to 1.09 (95% confidence interval 1.00-1.19) and for smoking-related cancers from 1.20 to 1.10 (95% confidence interval 1.00-1.21). CONCLUSION We conclude that the increased risk observed in the solely register-based study could partly be attributed to unmeasured confounding.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense C, Denmark
| | - Annette Kjaer Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen Ø, Denmark
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense C, Denmark
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