Inverse and Direct Cancer Comorbidity in People with Central Nervous System Disorders: A Meta-Analysis of Cancer Incidence in 577,013 Participants of 50 Observational Studies

Psychotherapy and Psychosomatics - Tập 83 Số 2 - Trang 89-105 - 2014
Ferrán Catalá-López1, Marta Suárez‐Pinilla2, Paula Suárez‐Pinilla3, José M Valderas4, Manuel Gómez-Beneyto3, Salvador Martı́nez5, Vicent Balanzá‐Martínez3, Joan Climent6, Alfonso Valencia7, John J. McGrath8, Benedicto Crespo‐Facorro3, José Sánchez‐Moreno3, Eduard Vieta3, Rafael Tabarés‐Seisdedos3,6,9
1Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency,
2Department of Neurology, Asturias Central Hospital, Oviedo,
3Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), and
4NIHR School for Primary Care Research, Health Services and Policy Research Group, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
5Instituto de Neurociencias de Alicante, Universidad Miguel Hernandez-Consejo Superior de Investigaciones Cientificas (CSIC), San Juan de Alicante, and
6Instituto de Investigación Sanitaria de Valencia (INCLIVA), Valencia,
7Spanish National Cancer Research Centre (CNIO), Madrid
8Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
9Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, and

Tóm tắt

<b><i>Background:</i></b> There is a lack of scientific consensus about cancer comorbidity in people with central nervous system (CNS) disorders. This study assesses the co-occurrence of cancers in patients with CNS disorders, including Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), autism spectrum disorders, Down's syndrome (DS), Huntington's disease (HD), multiple sclerosis (MS), Parkinson's disease (PD) and schizophrenia (SCZ). <b><i>Method:</i></b> Comprehensive search in PubMed/MEDLINE, Scopus and ISI Web of Knowledge of the literature published before March 2013. We identified 51 relevant articles from 2,229 discrete references, 50 of which contained data suitable for quantitative synthesis (577,013 participants). Pooled effect sizes (ES) were calculated using multiple random-effects meta-analyses. Sources of heterogeneity and uncertainty were explored by means of subgroup and sensitivity analyses, respectively. <b><i>Results:</i></b> The presence of CNS disorders was associated with a reduced co-occurrence of cancer (ES = 0.92; 95% confidence interval, CI: 0.87-0.98; I<sup>2</sup> = 94.5%). A consistently lower overall co-occurrence of cancer was detected in patients with neurodegenerative disorders (ES = 0.80; 95% CI: 0.75- 0.86; I<sup>2</sup> = 82.8%), and in those with AD (ES = 0.32; 95% CI: 0.22-0.46; I<sup>2</sup> = 0.0%), PD (ES = 0.83; 95% CI: 0.76-0.91; I<sup>2</sup> = 80.0%), MS (ES = 0.91; 95% CI: 0.87-0.95; I<sup>2</sup> = 30.3%) and HD (ES = 0.53; 95% CI: 0.42-0.67; I<sup>2</sup> = 56.4%). Patients with DS had a higher overall co-occurrence of cancer (ES = 1.46; 95% CI: 1.08-1.96; I<sup>2</sup> = 87.9%). No association was observed between cancer and ALS (ES = 0.97; 95% CI: 0.76-1.25; I<sup>2</sup> = 0.0%) or SCZ (ES = 0.98; 95% CI: 0.90-1.07; I<sup>2</sup> = 96.3%). Patients with PD, MS and SCZ showed (a) higher co-occurrence of some specific cancers (e.g. PD with melanoma, MS with brain cancers and SCZ with breast cancer), and (b) lower co-occurrence of other specific cancers (e.g. lung, prostate and colorectal cancers in PD; lung and prostate cancers in MS; and melanoma and prostate cancer in SCZ). <b><i>Conclusion:</i></b> Increased and decreased co-occurrence of cancer in patients with CNS disorders represents an opportunity to discover biological and non-biological connections between these complex disorders.

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Psychotherapy and Psychosomatics

Tập 83 Số 2

89-105

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