ObjectiveTo further evaluate the relation between usage of proton pump inhibitor (PPI) and the risk of pancreatic cancer. MethodThe observational studies were systematically searched in the databases of PubMed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov, CNKI, Wanfang, and VIP. The combined odds ratio (OR) and 95% confidence interval (CI) of pancreatic cancer risk were estimated by the corresponding effect model according to the heterogeneous results, and the subgroup analysis, meta-regression, and sensitivity analysis were performed. In addition, the relation between the defined daily dose (DDD) and usage time of PPI and the pancreatic cancer risk were studied by using restricted cubic spline. ResultsA total of 14 studies were included, including 1 601 430 subjects. The meta-analysis result showed that usage of PPI was positively correlated with the risk of pancreatic cancer [I2=98.9%, OR (95%CI)=1.60 (1.21, 2.11), P<0.001]. The subgroup analysis results showed that usage of PPI would increase the risk of pancreatic cancer in the subgroups of literature published before 2018 [OR (95%CI)=1.88 (1.05, 3.38), P=0.034], non-Asian regions [OR (95%CI)=1.37 (1.04, 1.82), P=0.028], case-control studies [OR (95%CI)=1.59 (1.16, 2.18), P=0.004], cohort studies [OR (95%CI)=1.65 (1.13, 2.39), P=0.009], and high-quality studies [OR (95%CI)=1.62 (1.19, 2.20), P=0.002]. The dose-response curve showed that there was a nonlinear relation between the usage of PPI and the risk of pancreatic cancer (χ2linear=2.27, P=0.132; Pnonlinear=0.039). When the usage of PPI was 800 DDD or less, usage of PPI would increase the risk of pancreatic cancer, but there was no statistical significance when the usage of PPI was more than 800 DDD. The time-effect curve showed that there was a linear relation between the usage time of PPI and the risk of pancreatic cancer (χ2linear=6.92, P=0.009), and the risk of pancreatic cancer would increase by 2.3% if the usage of PPI increased by one month [OR=1.02, 95%CI (1.01, 1.04), P=0.009]. The sensitivity analysis confirmed that the results were stable by gradually eliminating each study, the OR (95%CI) of the risk of pancreatic cancer was 1.37 (1.08, 1.74) to 1.66 (1.22, 2.27), and the publication bias was not found by Egger test (P=0.594).ConclusionsFrom the results of this meta-analysis, usage of PPI will increase the risk of pancreatic cancer, and the dosage of PPI and usage time of PPI may be related to the risk of pancreatic cancer. The clinical usage of PPI should be strictly controlled, and the dosage and usage time should also be carefully considered.
Dose-response meta-analysis (DRMA) is one of the branches of meta-analysis, which has provided important evidence for clinical research. Since introducing into China, it has gained great attention. In order to improve the reporting quality of DRMA, Dr. Chang Xu et al. developed the reporting guideline for DAMA——G-Dose Checklist. It was published in Chinese Jouranl of Evidence-based Medicine in 2016. This paper interprets the checklists so as to promote the understanding and use of it.
ObjectiveTo explore the dose-response relationship between coffee intake and all-cause mortality in patients with colorectal cancer, and to provide evidence-based support for improving the prognosis of patients with colorectal cancer. MethodsA comprehensive search was conducted in databases such as China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journal Full-text Database, China Biomedical Literature Database, Wanfang Data Knowledge Service Platform, PubMed, EMBase, Cochrane Library, and Web of Science for prospective cohort studies on the relationship between coffee intake and all-cause mortality in patients with colorectal cancer, up to December 2024. Literature was screened according to inclusion and exclusion criteria, and quality assessment and data extraction were performed. Data analysis was conducted using Stata 18.0 software. ResultsA total of 7 studies were included, involving 1 320 013 patients with colorectal cancer, with 11 550 all-cause deaths. The meta-analysis results showed that compared to colorectal cancer patients without coffee intake, those who with coffee intake had a lower risk of all-cause mortality [HR=0.66, 95%CI (0.53, 0.82)]. There was a negative linear relationship between coffee intake and all-cause mortality in patients with colorectal cancer (χ2=24.10, P<0.01), and for each additional cup of coffee consumed daily, the risk of all-cause mortality decreased by 2%. ConclusionsThere is a linear dose-response relationship between coffee intake and all-cause mortality in patients with colorectal cancer. An increase in coffee intake can reduce the risk of all-cause mortality in patients with colorectal cancer.
ObjectiveTo investigate the association between decline in intrinsic capacity (IC) and the risk of developing primary hepatic carcinoma (PHC), and to provide evidence for early identification and prevention of PHC. MethodsThis prospective cohort study included 347 874 participants without PHC at baseline from the UK Biobank. Following the World Health Organization framework, a composite IC score was constructed using 7 indicators across 4 domains: psychological, sensory, vitality, and locomotor function. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between IC decline score and incident PHC. ResultsDuring the follow-up period from 2006–2010 to 2022, with a median follow-up of 13.6 years, 801 incident PHC cases were identified. IC decline score showed a clear dose-response association [HR=1.18, 95%CI (1.11, 1.26)]. Compared with participants without IC decline, those with IC decline scores of 2, 3, and ≥4 had 35% [HR=1.35, 95%CI (1.10, 1.65)], 72% [HR=1.72, 95%CI (1.34, 2.20)], and 75% [HR=1.75, 95%CI (1.25, 2.45)] higher risks of PHC, respectively. Among individual indicators, slower walking speed [HR=1.33, 95%CI (1.07, 1.66)], lower grip strength [HR=1.38, 95%CI (1.18, 1.62)], and weight loss [HR=1.28, 95%CI (1.08, 1.54)] showed the strongest associations with PHC risk. ConclusionsDecline in IC is positively associated with the risk of PHC, demonstrating a clear dose-response relationship. Incorporating IC assessment into routine health management and screening strategies for high-risk populations may improve early risk stratification and inform targeted prevention strategies.
