PDF(Pubmed)
Abstract：
Despite 3 decades of study, there remains ongoing debate regarding whether vasectomy is associated with prostate cancer.
To determine if vasectomy is associated with prostate cancer.
The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched for studies indexed from database inception to March 21, 2017, without language restriction.
Cohort, case-control, and cross-sectional studies reporting relative effect estimates for the association between vasectomy and prostate cancer were included.
Two investigators performed study selection independently. Data were pooled separately by study design type using random-effects models. The Newcastle-Ottawa Scale was used to assess risk of bias.
The primary outcome was any diagnosis of prostate cancer. Secondary outcomes were high-grade, advanced, and fatal prostate cancer.
Fifty-three studies (16 cohort studies including 2 563 519 participants, 33 case-control studies including 44 536 participants, and 4 cross-sectional studies including 12 098 221 participants) were included. Of these, 7 cohort studies (44%), 26 case-control studies (79%), and all 4 cross-sectional studies were deemed to have a moderate to high risk of bias. Among studies deemed to have a low risk of bias, a weak association was found among cohort studies (7 studies; adjusted rate ratio, 1.05; 95% CI, 1.02-1.09; P < .001; I2 = 9%) and a similar but nonsignificant association was found among case-control studies (6 studies; adjusted odds ratio, 1.06; 95% CI, 0.88-1.29; P = .54; I2 = 37%). Effect estimates were further from the null when studies with a moderate to high risk of bias were included. Associations between vasectomy and high-grade prostate cancer (6 studies; adjusted rate ratio, 1.03; 95% CI, 0.89-1.21; P = .67; I2 = 55%), advanced prostate cancer (6 studies; adjusted rate ratio, 1.08; 95% CI, 0.98-1.20; P = .11; I2 = 18%), and fatal prostate cancer (5 studies; adjusted rate ratio, 1.02; 95% CI, 0.92-1.14; P = .68; I2 = 26%) were not significant (all cohort studies). Based on these data, a 0.6% (95% CI, 0.3%-1.2%) absolute increase in lifetime risk of prostate cancer associated with vasectomy and a population-attributable fraction of 0.5% (95% CI, 0.2%-0.9%) were calculated.
This review found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. There was a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design. This association is unlikely to be causal and should not preclude the use of vasectomy as a long-term contraceptive option.
To determine if vasectomy is associated with prostate cancer.
The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched for studies indexed from database inception to March 21, 2017, without language restriction.
Cohort, case-control, and cross-sectional studies reporting relative effect estimates for the association between vasectomy and prostate cancer were included.
Two investigators performed study selection independently. Data were pooled separately by study design type using random-effects models. The Newcastle-Ottawa Scale was used to assess risk of bias.
The primary outcome was any diagnosis of prostate cancer. Secondary outcomes were high-grade, advanced, and fatal prostate cancer.
Fifty-three studies (16 cohort studies including 2 563 519 participants, 33 case-control studies including 44 536 participants, and 4 cross-sectional studies including 12 098 221 participants) were included. Of these, 7 cohort studies (44%), 26 case-control studies (79%), and all 4 cross-sectional studies were deemed to have a moderate to high risk of bias. Among studies deemed to have a low risk of bias, a weak association was found among cohort studies (7 studies; adjusted rate ratio, 1.05; 95% CI, 1.02-1.09; P < .001; I2 = 9%) and a similar but nonsignificant association was found among case-control studies (6 studies; adjusted odds ratio, 1.06; 95% CI, 0.88-1.29; P = .54; I2 = 37%). Effect estimates were further from the null when studies with a moderate to high risk of bias were included. Associations between vasectomy and high-grade prostate cancer (6 studies; adjusted rate ratio, 1.03; 95% CI, 0.89-1.21; P = .67; I2 = 55%), advanced prostate cancer (6 studies; adjusted rate ratio, 1.08; 95% CI, 0.98-1.20; P = .11; I2 = 18%), and fatal prostate cancer (5 studies; adjusted rate ratio, 1.02; 95% CI, 0.92-1.14; P = .68; I2 = 26%) were not significant (all cohort studies). Based on these data, a 0.6% (95% CI, 0.3%-1.2%) absolute increase in lifetime risk of prostate cancer associated with vasectomy and a population-attributable fraction of 0.5% (95% CI, 0.2%-0.9%) were calculated.
This review found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. There was a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design. This association is unlikely to be causal and should not preclude the use of vasectomy as a long-term contraceptive option.
摘要：
尽管经过30年的研究，关于输精管结扎术是否与前列腺癌相关仍存在争议.
确定输精管结扎术是否与前列腺癌相关。
MEDLINE,EMBASE,WebofScience,和Scopus数据库检索了从数据库开始到2017年3月21日的索引研究,没有语言限制.
队列,病例控制，纳入了横断面研究,这些研究报告了输精管结扎术与前列腺癌之间的相关性的相对效应估计值.
两名研究者独立进行研究选择。使用随机效应模型按研究设计类型分别汇集数据。纽卡斯尔-渥太华量表用于评估偏倚风险。
主要结果是前列腺癌的任何诊断。次要结果是高等级，先进,和致命的前列腺癌.
53项研究（16项队列研究，包括2563519名参与者，33项病例对照研究，包括44536名参与者，和4项横断面研究，包括12098221名参与者）。其中,7项队列研究（44%），26项病例对照研究（79%），所有4项横断面研究均被认为存在中度至高度偏倚风险.在被认为具有低偏倚风险的研究中，在队列研究中发现弱关联(7项研究；调整后的比率，1.05；95%CI，1.02-1.09；P<.001；I2=9%），在病例对照研究中发现了相似但不显著的关联(6项研究；调整后的比值比，1.06；95%CI，0.88-1.29；P=.54；I2=37%）。当包括具有中度至高度偏倚风险的研究时，效果估计距离零进一步。输精管结扎术与高级别前列腺癌之间的关联(6项研究；调整后的比率，1.03；95%CI，0.89-1.21；P=.67；I2=55%），晚期前列腺癌(6项研究；调整后的比率，1.08；95%CI，0.98-1.20；P=.11；I2=18%），和致命的前列腺癌(5项研究；调整后的比率，1.02；95%CI，0.92-1.14；P=.68；I2=26%）无统计学意义（所有队列研究）。基于这些数据,经计算,与输精管切除术相关的前列腺癌终生风险绝对增加0.6%(95%CI,0.3%-1.2%),人群归因分数为0.5%(95%CI,0.2%-0.9%).
这篇综述没有发现输精管结扎术和高级别，高级阶段，或者致命的前列腺癌.输精管结扎术和任何前列腺癌之间的联系越来越弱，研究设计越来越可靠，更接近无效。这种关联不太可能是因果关系，不应排除使用输精管结扎术作为长期避孕选择。
确定输精管结扎术是否与前列腺癌相关。
MEDLINE,EMBASE,WebofScience,和Scopus数据库检索了从数据库开始到2017年3月21日的索引研究,没有语言限制.
队列,病例控制，纳入了横断面研究,这些研究报告了输精管结扎术与前列腺癌之间的相关性的相对效应估计值.
两名研究者独立进行研究选择。使用随机效应模型按研究设计类型分别汇集数据。纽卡斯尔-渥太华量表用于评估偏倚风险。
主要结果是前列腺癌的任何诊断。次要结果是高等级，先进,和致命的前列腺癌.
53项研究（16项队列研究，包括2563519名参与者，33项病例对照研究，包括44536名参与者，和4项横断面研究，包括12098221名参与者）。其中,7项队列研究（44%），26项病例对照研究（79%），所有4项横断面研究均被认为存在中度至高度偏倚风险.在被认为具有低偏倚风险的研究中，在队列研究中发现弱关联(7项研究；调整后的比率，1.05；95%CI，1.02-1.09；P<.001；I2=9%），在病例对照研究中发现了相似但不显著的关联(6项研究；调整后的比值比，1.06；95%CI，0.88-1.29；P=.54；I2=37%）。当包括具有中度至高度偏倚风险的研究时，效果估计距离零进一步。输精管结扎术与高级别前列腺癌之间的关联(6项研究；调整后的比率，1.03；95%CI，0.89-1.21；P=.67；I2=55%），晚期前列腺癌(6项研究；调整后的比率，1.08；95%CI，0.98-1.20；P=.11；I2=18%），和致命的前列腺癌(5项研究；调整后的比率，1.02；95%CI，0.92-1.14；P=.68；I2=26%）无统计学意义（所有队列研究）。基于这些数据,经计算,与输精管切除术相关的前列腺癌终生风险绝对增加0.6%(95%CI,0.3%-1.2%),人群归因分数为0.5%(95%CI,0.2%-0.9%).
这篇综述没有发现输精管结扎术和高级别，高级阶段，或者致命的前列腺癌.输精管结扎术和任何前列腺癌之间的联系越来越弱，研究设计越来越可靠，更接近无效。这种关联不太可能是因果关系，不应排除使用输精管结扎术作为长期避孕选择。
