Adiposity and cancer at major anatomical sites: umbrella review of the literature.
Adiposity and cancer at major anatomical sites: umbrella review of the literature.
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DOI：
10.1136/bmj.j477
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发表时间：
2017-02-28
期刊：
影响因子：
--
通讯作者：
Tsilidis KK
中科院分区：
文献类型：
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作者：
Kyrgiou M;Kalliala I;Markozannes G;Gunter MJ;Paraskevaidis E;Gabra H;Martin-Hirsch P;Tsilidis KK
目的 评估肥胖与患癌或死于癌症风险之间关联的证据强度和有效性。
设计 对系统综述和荟萃分析进行综合综述。
数据来源 PubMed、Embase、Cochrane系统评价数据库以及对检索到的参考文献进行人工筛选。
纳入标准 对肥胖指标与患癌或死于癌症风险之间的关联进行评估的观察性研究的系统综述或荟萃分析。
数据综合 主要分析侧重于队列研究，探索肥胖连续测量指标的关联。在应用包括随机效应汇总估计值和荟萃分析中最大研究的统计学意义、癌症病例数、研究间异质性、95%预测区间、小研究效应、过度显著偏倚以及具有可信度上限的敏感性分析等标准后，将证据分为强、高度提示性、提示性或弱。
结果 204项荟萃分析调查了7种肥胖指标与36种原发性癌症及其亚型的发生或死亡之间的关联。在纳入队列研究并使用连续量表测量肥胖的95项荟萃分析中，只有9种癌症的12项（13%）关联有强证据支持。体重指数增加与患食管腺癌、男性结肠癌和直肠癌、胆道系统和胰腺癌、绝经前女性子宫内膜癌、肾癌以及多发性骨髓瘤的风险较高有关。体重增加和腰臀比分别与从未使用过激素替代疗法的女性绝经后乳腺癌以及子宫内膜癌的较高风险有关。体重指数每增加5 kg/m²，患癌风险的增加幅度从男性直肠癌的9%（相对风险1.10，95%置信区间1.06 - 1.13）到胆道系统癌的56%（1.56，1.34 - 1.81）不等。从未使用过激素替代疗法的女性成年后体重每增加5 kg，绝经后乳腺癌风险增加11%（1.11，1.09 - 1.13），腰臀比每增加0.1，子宫内膜癌风险增加21%（1.21，1.13 - 1.29）。当纳入肥胖的分类测量指标时，另外5种关联有强证据支持：体重增加与结直肠癌；体重指数与胆囊癌、贲门癌和卵巢癌；以及多发性骨髓瘤死亡率。
结论 尽管肥胖与癌症风险的关联已被广泛研究，但只有11种癌症（食管腺癌、多发性骨髓瘤以及贲门癌、结肠癌、直肠癌、胆道系统癌、胰腺癌、乳腺癌、子宫内膜癌、卵巢癌和肾癌）的关联有强证据支持。其他关联可能是真实的，但仍存在很大的不确定性。肥胖正在成为公共卫生领域最大的问题之一；有关相关风险强度的证据可能有助于更精细地筛选出癌症高风险人群，这些人可成为个性化预防策略的目标。
Objective To evaluate the strength and validity of the evidence for the association between adiposity and risk of developing or dying from cancer. Design Umbrella review of systematic reviews and meta-analyses. Data sources PubMed, Embase, Cochrane Database of Systematic Reviews, and manual screening of retrieved references. Eligibility criteria Systematic reviews or meta-analyses of observational studies that evaluated the association between indices of adiposity and risk of developing or dying from cancer. Data synthesis Primary analysis focused on cohort studies exploring associations for continuous measures of adiposity. The evidence was graded into strong, highly suggestive, suggestive, or weak after applying criteria that included the statistical significance of the random effects summary estimate and of the largest study in a meta-analysis, the number of cancer cases, heterogeneity between studies, 95% prediction intervals, small study effects, excess significance bias, and sensitivity analysis with credibility ceilings. Results 204 meta-analyses investigated associations between seven indices of adiposity and developing or dying from 36 primary cancers and their subtypes. Of the 95 meta-analyses that included cohort studies and used a continuous scale to measure adiposity, only 12 (13%) associations for nine cancers were supported by strong evidence. An increase in body mass index was associated with a higher risk of developing oesophageal adenocarcinoma; colon and rectal cancer in men; biliary tract system and pancreatic cancer; endometrial cancer in premenopausal women; kidney cancer; and multiple myeloma. Weight gain and waist to hip circumference ratio were associated with higher risks of postmenopausal breast cancer in women who have never used hormone replacement therapy and endometrial cancer, respectively. The increase in the risk of developing cancer for every 5 kg/m2 increase in body mass index ranged from 9% (relative risk 1.09, 95% confidence interval 1.06 to 1.13) for rectal cancer among men to 56% (1.56, 1.34 to 1.81) for biliary tract system cancer. The risk of postmenopausal breast cancer among women who have never used HRT increased by 11% for each 5 kg of weight gain in adulthood (1.11, 1.09 to 1.13), and the risk of endometrial cancer increased by 21% for each 0.1 increase in waist to hip ratio (1.21, 1.13 to 1.29). Five additional associations were supported by strong evidence when categorical measures of adiposity were included: weight gain with colorectal cancer; body mass index with gallbladder, gastric cardia, and ovarian cancer; and multiple myeloma mortality. Conclusions Although the association of adiposity with cancer risk has been extensively studied, associations for only 11 cancers (oesophageal adenocarcinoma, multiple myeloma, and cancers of the gastric cardia, colon, rectum, biliary tract system, pancreas, breast, endometrium, ovary, and kidney) were supported by strong evidence. Other associations could be genuine, but substantial uncertainty remains. Obesity is becoming one of the biggest problems in public health; evidence on the strength of the associated risks may allow finer selection of those at higher risk of cancer, who could be targeted for personalised prevention strategies.