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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Thyroid cancer and renal transplantation: a meta-analysis

D Karamchandani, R Arias-Amaya, N Donaldson, J Gilbert, and KM Schulte.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

The review concluded that the standardised incidence rate of thyroid cancer was elevated in renal transplant recipients. The review had some methodological problems, but the authors’ conclusions were based on the evidence and appear appropriate. The pooled standardised incidence rates should be interpreted as estimates, rather than absolutes, due to the unknown quality of the included studies.

Authors' objectives

To evaluate the rate of thyroid cancer following renal transplantation.

Searching

PubMed was searched to January 2009 for published English-language articles. Search terms were reported. Reference lists of relevant articles were searched.

Study selection

Cohort studies of organ transplant recipients that reported the incidence and standardised incidence rate of thyroid cancer were eligible for inclusion. Studies had to match the transplant population to the standardised population to enable calculation the standardised incidence rate. Bone marrow transplantation studies and studies that did not confirm notification of cancer diagnosis at cancer registries were excluded.

The included retrospective cohort studies considered patients predominantly following renal transplantation, as well as multi-organ transplantation. The mean age of included patients, where reported, varied from 40 years to 53 years.

The authors stated that one reviewer identified the relevant publication and all authors reviewed the included studies.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Data on the standardised incidence rate was used to calculate relative risks (RRs) and 95% confidence intervals (CIs). Study authors were contacted for missing data.

The authors did not state how many reviewers undertook data extraction; they stated that two reviewers were involved in the statistical analysis.

Methods of synthesis

Pooled relative risks, together with 95% CIs, were calculated using a random-effects meta-analysis. Statistical heterogeneity was assessed using the Breslow-Day test. Publication bias was assessed using funnel plot analysis and Begg’s test. Sensitivity analysis was undertaken to determine the effects of individual studies on pooled results.

Results of the review

Nine retrospective cohorts were included in the review (n=51,339). Follow-up varied from 6.8 to 10.2 years.

The relative risk of increased standardised incidence rate for thyroid cancer following renal transplantation was 6.94 (95% CI 5.55 to 8.69; nine studies). There was no evidence of statistical heterogeneity. Sensitivity analysis indicated that the omission of any single study led to relative risks of between 6.13 (95% CI 4.92 to 7.64) and 8.01 (95% CI 6.83 to 9.40). Begg’s test revealed no evidence of publication bias.

Authors' conclusions

The standardised incidence rate of thyroid cancer was elevated in renal transplant recipients.

CRD commentary

Inclusion criteria for the review were broadly defined. One relevant database was searched. Publication bias was assessed and was not detected. There was potential for language bias as only English-language articles were included. Two authors appeared to be involved in selecting studies and performing statistical analysis, which minimised the risk of error and bias in the analysis. Study quality assessment was not reported, which made determining study quality difficult; however, all studies were retrospective cohorts, which can be prone to high levels of bias. Studies were combined using meta-analysis and heterogeneity was assessed, which was appropriate.

There were some methodological problems with the review, but the authors’ conclusions were based on the evidence and appear appropriate. Given the unknown quality of the included studies, the pooled standardised incidence rates should be interpreted as estimates, rather than absolutes.

Implications of the review for practice and research

Practice: The authors stated that this review supported use of thyroid ultrasound pre- and post-transplant to ensure timely detection of curable disease.

Research: The authors stated that it would be interesting to determine whether the risk of cancer (specifically thyroid) was elevated in other immunodeficient populations.

Funding

No funding.

Bibliographic details

Karamchandani D, Arias-Amaya R, Donaldson N, Gilbert J, Schulte KM. Thyroid cancer and renal transplantation: a meta-analysis. Endocrine-Related Cancer 2010; 17(1): 159-167. [PubMed: 19942714]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adult; Carcinoma, Papillary, Follicular /epidemiology /etiology; Follow-Up Studies; Humans; Incidence; Kidney Transplantation /adverse effects /physiology /statistics & numerical data; Middle Aged; Risk Factors; Thyroid Neoplasms /epidemiology /etiology

AccessionNumber

12010002449

Database entry date

19/01/2011

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 19942714