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Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis
BACKGROUND: Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents. METHODS: We searche...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150859/ https://www.ncbi.nlm.nih.gov/pubmed/37027286 http://dx.doi.org/10.1097/CM9.0000000000002514 |
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author | Ma, Ye You, Wen Cao, Yang He, Xuxia Wang, Jing Zhang, Yuelun Li, Ji Li, Jingnan |
author_facet | Ma, Ye You, Wen Cao, Yang He, Xuxia Wang, Jing Zhang, Yuelun Li, Ji Li, Jingnan |
author_sort | Ma, Ye |
collection | PubMed |
description | BACKGROUND: Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents. METHODS: We searched PubMed, Embase, and the Cochrane Library for studies published in English until October 31, 2021 that fit our inclusion criteria. We performed a systematic review and network meta-analysis to assess the comparative efficacy and safety of candidate agents (low-dose aspirin [Asp], high-dose Asp, cyclooxygenase-2 inhibitors [coxibs], calcium, vitamin D, folic acid, ursodeoxycholic acid [UDCA], estrogen, and progesterone, alone or in combination) for preventing colorectal adenoma and CRC. Cochrane risk-of-bias assessment tool was employed to evaluate the quality of each included study. RESULTS: Thirty-two randomized controlled trials (278,694 participants) comparing 13 different interventions were included. Coxibs significantly reduced the risk of colorectal adenoma (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44–0.79, six trials involving 5486 participants), advanced adenoma (RR: 0.63, 95% CI: 0.43–0.92, four trials involving 4723 participants), and metachronous adenoma (RR: 0.58, 95% CI: 0.43–0.79, five trials involving 5258 participants) compared with placebo. Coxibs also significantly increased the risk of severe adverse events (RR: 1.29, 95% CI: 1.13–1.47, six trials involving 7109 participants). Other interventions, including Asp, folic acid, UDCA, vitamin D, and calcium, did not reduce the risk of colorectal adenoma in the general and high-risk populations compared with placebo. CONCLUSIONS: Considering the balance between benefits and harms, regular use of coxibs for prevention of colorectal adenoma was not supported by the current evidence. Benefit of low-dose Asp for chemoprevention of colorectal adenoma still requires further evidence. REGISTRATION: PROSPERO, No. CRD42022296376 |
format | Online Article Text |
id | pubmed-10150859 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-101508592023-05-02 Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis Ma, Ye You, Wen Cao, Yang He, Xuxia Wang, Jing Zhang, Yuelun Li, Ji Li, Jingnan Chin Med J (Engl) Meta Analysis BACKGROUND: Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents. METHODS: We searched PubMed, Embase, and the Cochrane Library for studies published in English until October 31, 2021 that fit our inclusion criteria. We performed a systematic review and network meta-analysis to assess the comparative efficacy and safety of candidate agents (low-dose aspirin [Asp], high-dose Asp, cyclooxygenase-2 inhibitors [coxibs], calcium, vitamin D, folic acid, ursodeoxycholic acid [UDCA], estrogen, and progesterone, alone or in combination) for preventing colorectal adenoma and CRC. Cochrane risk-of-bias assessment tool was employed to evaluate the quality of each included study. RESULTS: Thirty-two randomized controlled trials (278,694 participants) comparing 13 different interventions were included. Coxibs significantly reduced the risk of colorectal adenoma (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44–0.79, six trials involving 5486 participants), advanced adenoma (RR: 0.63, 95% CI: 0.43–0.92, four trials involving 4723 participants), and metachronous adenoma (RR: 0.58, 95% CI: 0.43–0.79, five trials involving 5258 participants) compared with placebo. Coxibs also significantly increased the risk of severe adverse events (RR: 1.29, 95% CI: 1.13–1.47, six trials involving 7109 participants). Other interventions, including Asp, folic acid, UDCA, vitamin D, and calcium, did not reduce the risk of colorectal adenoma in the general and high-risk populations compared with placebo. CONCLUSIONS: Considering the balance between benefits and harms, regular use of coxibs for prevention of colorectal adenoma was not supported by the current evidence. Benefit of low-dose Asp for chemoprevention of colorectal adenoma still requires further evidence. REGISTRATION: PROSPERO, No. CRD42022296376 Lippincott Williams & Wilkins 2023-04-05 2023-03-29 /pmc/articles/PMC10150859/ /pubmed/37027286 http://dx.doi.org/10.1097/CM9.0000000000002514 Text en Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
spellingShingle | Meta Analysis Ma, Ye You, Wen Cao, Yang He, Xuxia Wang, Jing Zhang, Yuelun Li, Ji Li, Jingnan Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
title | Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
title_full | Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
title_fullStr | Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
title_full_unstemmed | Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
title_short | Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
title_sort | chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis |
topic | Meta Analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10150859/ https://www.ncbi.nlm.nih.gov/pubmed/37027286 http://dx.doi.org/10.1097/CM9.0000000000002514 |
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