CANCER RISK IN PATIENTS WITH ATOPIC DERMATITIS: A SYSTEMATIC REVIEW - - PowerPoint PPT Presentation
CANCER RISK IN PATIENTS WITH ATOPIC DERMATITIS: A SYSTEMATIC REVIEW Lily Wang, MD(C) CSIM Annual Meeting 2018 October 11, 2018 DISCLOSURE Relevant relationships with commercial entities None Potential for conflicts of interest
Lily Wang, MD(C) CSIM Annual Meeting 2018 October 11, 2018
Boguniewicz, M and Leung D YM. (2011)
– a.k.a. non-melanoma skin cancer
Jain et al. (1991) Silverman et al (1999) Schuz et al. (2003) Spector et al. (2004)
Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Moher et al., Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 2009; 4: 264-9
– Intervention: exp Dermatitis, Atopic/ OR (atopic adj1 (dermatit* or neurodermatit*)).tw. OR eczema.tw. OR disseminated neurodermatit*.tw. – Outcomes: neoplas*.tw. OR exp Neoplasms/ OR tumo*.tw. OR cancer*.tw. OR malignanc*.tw. – Design: observational (cohort (CO) and case control (CC)) study design
(1946 – Present) (1991 – Present)
Searching
Manual
– Bias due to confounding – Bias in selection of participants into the study – Bias in classification of interventions – Bias due to deviations from intended interventions – Bias due to missing data – Bias in measurement of outcomes – Bias in selection of the reported result
(Cochrane Library software, Oxford, UK)
– Significance by Cochran’s Q; P < 0.10 – Quantification with I2 statistic
Grading of Recommendations Assessment, Development and Evaluation for quality of evidence (GRADE)
GRADE Definition High Further research is very unlikely to change our confidence in the estimate of effect Moderate Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate Low Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate Very low Any estimate of effect is very uncertain Downgrade Study limitation (risk of bias) Inconsistency (unexplained heterogeneity) Indirectness (low generalizability) Imprecision (small sample size, wide CI) Publication bias
Schủnemann H, Brozek J, Guyatt G, editors. The GRADE handbook [updated October 2013]. The GRADE Working Group, 2016
SIR 1.80 [95% CI: 1.05, 3.08] SIR 1.86 [95% CI: 1.14, 3.04] SIR 1.90 [95% CI: 1.03, 3.50]
SIR 1.46 [95% CI: 1.20, 1.77] Case controls OR 1.53 [95% CI: 1.08, 2.18]
Study Domain Arana Hagstromer Hwang Jensen Juan Montgomery Olesen Soderberg Schwartzbaum Bias due to confounding Serious risk Moderate risk Serious risk Moderate risk Serious risk Moderate risk Serious risk Moderate risk Serious risk Bias in selection of participants into the study Serious risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Bias in classification of interventions Low risk Moderate risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Bias due to deviations from intended interventions Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Low risk Bias due to missing data Low risk Low risk Serious risk Low risk Low risk Serious risk Low risk No info Moderate risk Bias in measurement of outcomes Low risk Low risk Low risk Low risk Low risk Moderate risk Low risk Low risk Low risk Bias in selection of the reported result Low risk Low risk Low risk Moderate risk Low risk Low risk Low risk Low risk Moderate risk Overall Serious risk Moderate risk Serious risk Moderate risk Serious risk Moderate risk Serious risk Moderate risk Serious risk
1.08, 2.18]
1. No information about AD diagnosis criteria 2. Detection bias
Selected studies from database and manual searches Full article review Final studies included in meta-analysis Exclusion based on title and abstract Exclusion based on full review of article