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Abstract
The growth hormone (GH) replacement therapy in adult growth hormone deficiency (AGHD) is now well developed, nevertheless, the safety of GH replacement, especially the incidence of cancer in these patients remains to be further clarified. To summarize the evidence on the safety of using GH in AGHD, we conduct this meta-analysis to assess the relationship between the risk of cancer and GH replacement therapy. Randomized controlled trials and cohort studies involved in GH therapy for AGHD were selected. Meta-analysis was performed and risk ratio (RR) was pooled with 95% confidence interval (CI) to investigate the relationship between GH replacement and the risk of cancer. The result indicated that there was no evidence to draw a conclusion that GH replacement therapy will increase the risk of cancer (P = 0.001, RR = 0.77, 95% CI [0.65, 0.90]). Meanwhile, according to the calculated analysis, the replacement therapy might even reduce the risk of cancer. Furthermore, subgroup analysis demonstrated that there was no correlation between replacement therapy of GH and the risk of cancer both in prospective and retrospective cohort design research, and in prospective group, the risk of cancer even decreased (P = 0.0002, RR = 0.71, 95%CI [0.59, 0.85]). In conclusion, our study corroborates evidence from previous studies showing that GH replacement therapy in AGHD patients would not increase the risk of cancer; instead, it might be even decrease cancer risk. The results suggested that GH replacement therapy in AGHD patients was safe.
Highlights
Growth hormone (GH) was originally used to remedy short stature in childhood [1]
The result indicated that there was no evidence to draw a conclusion that growth hormone (GH) replacement therapy will increase the risk of cancer (P = 0.001, risk ratio (RR) = 0.77, 95% confidence interval (CI) [0.65, 0.90])
Keywords included in the search were “growth hormone deficiency/GHD/AGHD/adult growth hormone deficiency/hypopituitarism” AND “GH therapy/GH treatment/growth hormone treatment/growth hormone therapy/replacement” AND “cancer/tumor/neoplasm” All our work in this systematic review referred to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [9]
Summary
Growth hormone (GH) was originally used to remedy short stature in childhood [1]. As experience with the treatment improved, the range of indications was expanded. The biological effect of GH is associated with the GH-GH receptor-insulin-like growth factor 1 (IGF-1) axis, while IGF-1 has significant effects on cell proliferation and differentiation [2]. Epidemiological studies had shown a relationship between elevated circulating levels of IGF-1 and an increased risk of several types of cancers such as prostate, colorectal and breast neoplasms [3] [4] [5]. The association between GH-IGF axis and carcinogenesis was announced by the study in which patients enrolled suffering from acromegaly, which characterized by hypersecretion of GH and elevated levels of IGF-1. There is ongoing concern about the potential mitogenic property of GH-IGF-1 axis and the safety of GH replacement in adult because of currently widely used of GH replacement therapy
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