| 【Background】Now,bladder cancer is currently the ninth most common malignant tumor in the world and one of the most common malignant tumors in the urinary system.Male bladder cancer is more common than female bladder cancer,and the ratio of male to female bladder cancer incidence is about 3:1.The incidence of bladder cancer ranks first among malignant tumors of the genitourinary system in China,and the annual incidence is on the rise.About 70% of bladder cancer cases are non-muscle invasive bladder cancer(NMIBC).10%～30% of NMIBC patients still progress to muscular invasive bladder cancer after surgery,and the recurrence rate can reach 40%～50% within 5 years.A considerable number of studies have shown that diabetes(Diabetes mellitus,DM),especially Type 2 diabetes mellitus(T2DM),is associated with an increased risk of cancer in various locations.Although there are many studies that have evaluated the correlation between DM and bladder cancer,whether the correlation between DM and bladder cancer varies with different characteristics of patients is unclear and needs further verification.DM is an important component of Metabolic syndrome(MetS).As the incidence of MetS increases year by year,people are paying or have paid more and more attention to the relationship between MetS and the occurrence and development of cancer.As there are few reports on the correlation between MetS patients and the development of bladder cancer,only a few studies have evaluated the relationship between MetS and the development of bladder cancer.Therefore,in order to further understand the relationship between DM and MetS and the pathophysiology of bladder cancer,we conducted a detailed evidence-based medicine study on 68 published case-control studies and cohort studies to provide prevention and treatment for patients with bladder cancer.And prognosis to provide evidence-based basis.【Objective】To analyze the impact of diabetes mellitus and metabolic syndrome on the risk of bladder cancer incidence,recurrence,progression and death.【Methods】Collect literatures on diabetes,metabolic syndrome and bladder cancer from the database of Pub Med,MEDLINE and EMBASE until February 2021.According to the inclusion and exclusion criteria,preliminary screening,re-screening and data extraction of literature were carried out.Meta-analysis was performed using STATA 16.0 software to evaluate the impact of diabetes and metabolic syndrome on the incidence,recurrence,progression and death of bladder cancer in the general population.At the same time,sensitivity analysis was performed,and the potential confounding effect was studied using hierarchical meta-analysis.Finally,a cumulative Meta analysis is performed to evaluate the cumulative effect estimates over time.【Results】In the study on diabetes,a total of 58 articles of 29 case-control studies and 29 cohort studies are included in this article,providing information on 20 million subjects and140,000 bladder cancer patients,showing the risk of diabetes and bladder cancer.Estimated value of the relationship between the risk of recurrence.The combined effect estimate shows that the relative risk(RR)is 1.23(95% CI: 1.18-1.29).Stratified analysis found that diabetes combined with obesity(RR=1.25;95%CI: 0.98-1.59;p<0.01)and insulin(RR=1.12;95%CI: 0.99-1.26;p=0.5)or metformin(RR= 1.05;95% CI: 0.64-1.72;p<0.01)There was no statistically significant increase in the risk of bladder cancer in patients treated with diabetes.In the studies on metabolic syndrome,6 case-control studies and 6 cohort studies,including 12 articles,were included in this study,providing information on 20,000 bladder cancer patients,showing the metabolic syndrome and the risk of bladder cancer and the risk of recurrence.The effect size of the relationship between the combined effect size shows that the relative risk(RR)is 1.19(95% CI:1.10-1.30).Interestingly,regarding the relationship between metabolic syndrome and bladder cancer,stratified analysis found that it includes hypertension(RR=1.60;95%CI:0.97-2.65;p<0.01)and hyperlipidemia(RR=1.33);95%CI: 0.70-2.53;p<0.01)MetS patients have no statistically significant increase in the risk of bladder cancer.Excluding any one study,the sensitivity analysis did not significantly change the combined RR.【Conclusions】1.Diabetes patients have an increased risk of bladder cancer onset,recurrence,progression and death.Diabetes is an important risk factor affecting the onset of bladder cancer.2.Among diabetic patients,patients with obesity and those who use insulin or metformin for diabetes have no statistically significant increase in bladder cancer risk.This may mean that obesity and metformin or insulin treatment for diabetes may not be a risk factor for increased risk of bladder cancer.3.Diabetes and obesity combined with other components of MetS may be an important factor in the incidence,recurrence,progression and death of bladder cancer.However,MetS patients with hypertension and hyperlipidemia have no significant correlation with bladder cancer. |
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