For stomach cancer and pancreatic cancer, there were four studies and three studies, respectively. One study by Landgren et al.13 involving a large number of male PBC patients found that PBC patients had increased risk of stomach cancer (RR, 1.66; 95% CI, 1.10-2.51) and pancreatic cancer (RR, 2.06; 95% CI, 1.44-2.96). Other studies showed no significant association between PBC and risk C59 wnt solubility dmso of these two cancers in mixed-sex patient groups. For analysis of pooling more than three individual studies, sensitivity analysis was performed to examine the stability and reliability

of pooled RRs by sequential omission of individual studies. The results indicate that the significance estimate of pooled RRs was not significantly influenced by omitting any single study. Because it is unlikely that funnel plots will be useful in meta-analyses containing fewer than five studies,32 the publication bias was evaluated by Funnel plot and Egger’s Kinase Inhibitor Library cell line test only for meta-analyses of pooling five or more individual studies. Funnel plot shapes showed no obvious evidence of asymmetry, and all the P values of Egger’s

tests were over 0.05 (Supporting Files 2-6). These results suggest that publication bias was not evident in various meta-analyses. This is, to our knowledge, the first systematic review and meta-analysis to assess the association between PBC and cancer risk. Using the NOS, we found that the majority of studies included in this meta-analysis were of high quality (13 studies with score of 7 or more), and only one study was of low quality (score of 3). The results of this study indicate that PBC is significantly

Florfenicol associated with an increased risk of overall cancer and HCC but not other cancers. In addition, we could not draw a consistent conclusion about the association of PBC with the risks of stomach and pancreatic cancers; this association needs to be examined further in a larger number of studies. Several studies examining the risk of malignancy in PBC patients have yielded diverse results. Some data have revealed an increased overall cancer risk,11, 12, 23-26 whereas others disagree.21, 22, 27 The present study, with more strong evidence via meta-analysis of published studies, confirmed that there is increased risk of overall malignancy in PBC patients. Compared with non-PBC individuals, PBC patients may have an approximately 55% increased risk of overall malignancies. Furthermore, subgroup meta-analyses showed that PBC still remained significantly associated with increased risk of overall cancers in the majority of subgroups, with the exception of one subgroup for studies with RR as a measurement of risk. The lack of a significant risk increase in this subgroup may be due to the small number of studies (only three) with significant heterogeneity (I2 = 52.4%).