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The use of bisphosphonates and the risk ofesophageal cancer have recently received increasing concem and rehted studies have yielded controversial results.The present meta-analysis of observational studies shows that no clear association between bisphosphonate treatment and risk of esophageal uancer was obseved.Introduction Epidemiological evidence suggests that bisphosphonate trentment can increase the risk of esophageal cancer.However,data on this issue are unstable and controversial.We conducted a meta-analysis to provide a quantitaive assessment of the association between use of bisphosphonates and risk of esophageal cancer.Methods We searched the Medline and Embase databases up to May 2012 to identify studies related to bisphosphonates end esophagesl cancer.Summary effect estimates with 95%confidence intervals (CI) were derived using a fixed or random effects model,depending on the heterogeneity of the included studies.Results Seven epidemiologic studies that consisted of four cohort studies and three case-control studies were included hate treatment was not associated with risk of esophageal cancer in both cohort studies [pooled relative risk (RR) 1.23,95%CI 0.79-1.92] and case-control studies [pooled odds ratio (OR) 1.24,95%CI 0.98-1.57].Evidence for the presence of significant haerogeneity wes found in cohort studies (p=0.009,I2=74%) but not in case-control studies (p=0.338,l2=7.8%).In our secondary analysis,no significant inceased risk of esophageal cancer was found in alendronate users (pooled RR 1.08,95%CI 0.67-1.75 in cohort studies; pooled OR i.16,95%CI 0.82-1.63 in casecontrol studies).Conclusions Based on current evidences,bisphosphonate treatment was not significantly associated with excess risk of esophagesl cancer.