Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis.

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Clinical Gastroenterology and Hepatology Pub Date : 2024-10-05 DOI:10.1016/j.cgh.2024.07.046
Daniele Piovani, Georgios K Nikolopoulos, Alessio Aghemo, Ana Lleo, Saleh A Alqahtani, Cesare Hassan, Alessandro Repici, Stefanos Bonovas
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Abstract

Background & aims: Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.

Methods: We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.

Results: We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] per 5-unit increase, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR per 5-cm increase, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.

Conclusions: This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).

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胆囊癌的环境风险因素:全领域系统回顾和荟萃分析。
背景和目的:胆石症是胆囊癌(GBC)--主要的胆道恶性肿瘤--最公认的风险因素;然而,其他可改变的暴露因素的可信度仍不确定。我们对与胆囊癌相关的环境因素进行了全领域的系统回顾和荟萃分析:我们系统地检索了 Medline/PubMed 和 Embase(截至 2023 年 5 月 8 日),以确定研究 GBC 环境因素的随机和非随机研究。我们对纵向研究进行了随机效应荟萃分析。病例对照研究的证据被视为补充。证据可信度按照预先规定的标准进行分级,包括随机效应估计值、95% 置信区间、P 值、统计异质性、小型研究效应以及对未测量混杂因素的稳健性:我们确定了 215 项符合条件的主要研究,并在生活方式、生殖、代谢、饮食、感染、干预、污染物和职业暴露等七个领域进行了 350 项元分析。根据纵向证据,体重指数(RR 每增加 5 个单位为 1.27;95% CI,1.21-1.33)、臀围(RR 每增加 5 厘米为 1.16;1.11-1.22)、胆管感染(RR 31.7;24.8-40.6)、高妊娠率(RR 1.48;1.30-1.68)、肥胖(RR 1.70;1.44-2.01)、超重(RR 1.28;1.14-1.43)、腰围(每增加 5 厘米,RR 为 1.14;1.10-1.18)和腰围身高比(每增加 0.1 厘米,RR 为 1.49;1.36-1.64)与 GBC 风险增加密切相关,而高学历(RR 为 0.63;0.49-0.82)则与风险降低相关(可信度为中高水平)。另外 39 项重要关联的可信度较低,包括吸烟、饮酒和体育锻炼不足的不同暴露情景:本研究详细评估并绘制了有关可改变 GBC 的因素的证据图谱。进一步开展高质量的前瞻性研究对于验证新出现的关联并为高发地区的预防策略提供信息至关重要。
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来源期刊
CiteScore
16.90
自引率
4.80%
发文量
903
审稿时长
22 days
期刊介绍: Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.
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