吸烟和胰腺癌的关系的病例回顾：观察性研究的质量是否影响荟萃分析的结果？
2010/01/07
目的：对吸烟和胰腺癌的关联的观察性研究进行荟萃分析，并特别关注研究的质量对荟萃分析结果的影响程度。
方法：检索PubMed 和EMBASE数据库上截止到2008年2月15日的数据。关键词为"pancreatic neoplasms（胰腺赘生物）," "pancreatic cancer（胰腺癌）," "smoking（吸烟）," "smoke（烟）," "cigarette（香烟）," "case-control studies（病例-对照研究）,"以及"cohort studies（群组研究）."挑选出关于吸烟与胰腺癌关系的研究并评价其质量。使用STATA 9.0统计软件进行分析。
结果：共选择了6个队列研究和24个病例-对照研究，平均的质量积分分别为8和10。 病例-对照研究的优势比（OR）和队列研究的风险比（RR）分别是1.45 (95% 可信区间 [CI], 1.33-1.57) 和1.78 (95% CI, 1.64-1.92)。在进行质量积分分层后，高质量积分的病例对照研究的OR值为1.38 (95% CI, 1.27-1.49), 而其他研究的OR 值为 1.52 (95% CI, 1.34-1.73)。对高质量积分及低质量积分的队列研究的荟萃分析显示风险比RR值分别为1.74 (95% CI, 1.61-1.90) 和 2.10 (95% CI, 1.64-2.67)。
结论：证据显示吸烟是胰腺癌的一个重要危险因素，但是二者相关性的评估很大程度依赖于研究的质量。
（张永明编译 刘国梁审校）
Pancreas. 38(3):241-247, April 2009.
Does Quality of Observational Studies Affect the Results of a Meta-Analysis?: The Case of Cigarette Smoking and Pancreatic Cancer.
La Torre, Giuseppe MD, MPH, DSc *; de Waure, Chiara MD *; Specchia, Maria Lucia MD, MPH, PhD *; Nicolotti, Nicola MD *; Capizzi, Silvio MD *; Bilotta, Antonella MSc *; Clemente, Gennaro MD +; Ricciardi, Walter MD, MPH, MSc *
From the *Epidemiology and Biostatistics Unit, Institute of Hygiene; and +Department of Surgery-Hepatobiliary Unit, Catholic University of the Sacred Heart, Rome, Italy.
Objectives: A meta-analysis of observational studies on association between cigarette smoking and pancreatic cancer was performed to focus, particularly, on the role of the studies’ quality in affecting meta-analysis results.
Methods: A bibliographic search was carried out on PubMed and EMBASE databases until February 15, 2008. Key words were "pancreatic neoplasms," "pancreatic cancer," "smoking," "smoke," "cigarette," "case-control studies," and "cohort studies." Studies about cigarette smoking and pancreatic cancer were selected and assessed on quality. STATA 9.0 was used.
Results: Six cohort studies and 24 case-control studies were selected, with median quality scores of 8 (range, 3) and 10 (range, 8), respectively. Pooled case-control studies’ odds ratio (OR) and cohort studies’ risk ratio were, respectively, 1.45 (95% confidence interval [CI], 1.33-1.57) and 1.78 (95% CI, 1.64-1.92). After stratifying for quality scoring, high-quality-scored case-control studies yielded an OR of 1.38 (95% CI, 1.27-1.49), whereas the others gave an OR of 1.52 (95% CI, 1.34-1.73). The results of meta-analysis for cohort studies showed a risk ratio of 1.74 (95% CI, 1.61-1.90) and of 2.10 (95% CI, 1.64-2.67), respectively, for high- and low-quality score studies.
Conclusions: There is evidence that cigarette smoking is an important risk factor for pancreatic cancer, but the estimate of the association greatly relies on the studies’ quality.
Accession Number 00006676-200904000-00001.
DOI Number 10.1097/MPA.0b013e318190d795
方法：检索PubMed 和EMBASE数据库上截止到2008年2月15日的数据。关键词为"pancreatic neoplasms（胰腺赘生物）," "pancreatic cancer（胰腺癌）," "smoking（吸烟）," "smoke（烟）," "cigarette（香烟）," "case-control studies（病例-对照研究）,"以及"cohort studies（群组研究）."挑选出关于吸烟与胰腺癌关系的研究并评价其质量。使用STATA 9.0统计软件进行分析。
结果：共选择了6个队列研究和24个病例-对照研究，平均的质量积分分别为8和10。 病例-对照研究的优势比（OR）和队列研究的风险比（RR）分别是1.45 (95% 可信区间 [CI], 1.33-1.57) 和1.78 (95% CI, 1.64-1.92)。在进行质量积分分层后，高质量积分的病例对照研究的OR值为1.38 (95% CI, 1.27-1.49), 而其他研究的OR 值为 1.52 (95% CI, 1.34-1.73)。对高质量积分及低质量积分的队列研究的荟萃分析显示风险比RR值分别为1.74 (95% CI, 1.61-1.90) 和 2.10 (95% CI, 1.64-2.67)。
结论：证据显示吸烟是胰腺癌的一个重要危险因素，但是二者相关性的评估很大程度依赖于研究的质量。
（张永明编译 刘国梁审校）
Pancreas. 38(3):241-247, April 2009.
Does Quality of Observational Studies Affect the Results of a Meta-Analysis?: The Case of Cigarette Smoking and Pancreatic Cancer.
La Torre, Giuseppe MD, MPH, DSc *; de Waure, Chiara MD *; Specchia, Maria Lucia MD, MPH, PhD *; Nicolotti, Nicola MD *; Capizzi, Silvio MD *; Bilotta, Antonella MSc *; Clemente, Gennaro MD +; Ricciardi, Walter MD, MPH, MSc *
From the *Epidemiology and Biostatistics Unit, Institute of Hygiene; and +Department of Surgery-Hepatobiliary Unit, Catholic University of the Sacred Heart, Rome, Italy.
Objectives: A meta-analysis of observational studies on association between cigarette smoking and pancreatic cancer was performed to focus, particularly, on the role of the studies’ quality in affecting meta-analysis results.
Methods: A bibliographic search was carried out on PubMed and EMBASE databases until February 15, 2008. Key words were "pancreatic neoplasms," "pancreatic cancer," "smoking," "smoke," "cigarette," "case-control studies," and "cohort studies." Studies about cigarette smoking and pancreatic cancer were selected and assessed on quality. STATA 9.0 was used.
Results: Six cohort studies and 24 case-control studies were selected, with median quality scores of 8 (range, 3) and 10 (range, 8), respectively. Pooled case-control studies’ odds ratio (OR) and cohort studies’ risk ratio were, respectively, 1.45 (95% confidence interval [CI], 1.33-1.57) and 1.78 (95% CI, 1.64-1.92). After stratifying for quality scoring, high-quality-scored case-control studies yielded an OR of 1.38 (95% CI, 1.27-1.49), whereas the others gave an OR of 1.52 (95% CI, 1.34-1.73). The results of meta-analysis for cohort studies showed a risk ratio of 1.74 (95% CI, 1.61-1.90) and of 2.10 (95% CI, 1.64-2.67), respectively, for high- and low-quality score studies.
Conclusions: There is evidence that cigarette smoking is an important risk factor for pancreatic cancer, but the estimate of the association greatly relies on the studies’ quality.
Accession Number 00006676-200904000-00001.
DOI Number 10.1097/MPA.0b013e318190d795
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