Tumor Biology

, Volume 35, Issue 3, pp 2095–2102 | Cite as

Pioglitazone prescription increases risk of bladder cancer in patients with type 2 diabetes: an updated meta-analysis

  • Shiyao He
  • Yu-hong Tang
  • Guobin Zhao
  • Xiaolong Yang
  • Dehou Wang
  • Ye ZhangEmail author
Research Article


Pioglitazone is widely used for glycemic control in patients with type 2 diabetes mellitus, but evidence regarding the association between pioglitazone and bladder cancer risk is confusing. A systematic search of databases was carried out, and other relevant papers were also identified. Then, the analyses were conducted according to the PRISMA and MOOSE guidelines. After quality assessment, nine datasets from 10 available studies were included on the basis of inclusion criteria. The incidence of bladder cancer among pioglitazone ever users and never users, pooled from four cohort and one randomized studies, were 84.51 and 66.68 per 100,000 person-years, respectively. Nine studies representing 2,596,856 diabetic patients were recognized as eligible for overall study; the result suggested an increased risk of bladder cancer in patients exposed to pioglitazone. A persistent significance was detected after being adjusted by age, gender, and use of other diabetes medications. Subgroup analyses indicated that the significantly increased incidence of bladder cancer was found in men, but not in women. Additionally, the analyses addressing increasing exposure to pioglitazone observed a dose–response relation between exclusive ever use of pioglitazone and bladder cancer in terms of cumulative duration of use and cumulative dosage. With some limitations, our results suggest an increased risk of bladder cancer in diabetic patients using pioglitazone, especially for men with long-term and high-dose exposure. Additional studies are needed to provide more precise evidences to support our results.


Pioglitazone Bladder cancer Diabetes Meta-analysis 



The authors thank all of the authors of primary studies included in their meta-analyses.

Conflicts of interest


Supplementary material

13277_2013_1278_MOESM1_ESM.pdf (155 kb)
ESM 1 (PDF 155 kb)


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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2013

Authors and Affiliations

  • Shiyao He
    • 1
  • Yu-hong Tang
    • 2
  • Guobin Zhao
    • 3
  • Xiaolong Yang
    • 4
  • Dehou Wang
    • 4
  • Ye Zhang
    • 4
    Email author
  1. 1.Department of UrologyWu Qing District People’s HospitalTianjinChina
  2. 2.College of Laboratory MedicineHebei North UniversityZhangjiakouChina
  3. 3.Department of UrologyThe First Affiliated Hospital of Hebei North UniversityZhangjiakouChina
  4. 4.Department of UrologyAffiliated Hospital of Yan’an UniversityYananChina

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