Van Maele-Fabry Geneviève, Libotte Valérie, Willems Jan, Lison Dominique
Unité de Toxicologie Industrielle et Médecine du travail, Ecole de Santé Publique, Université Catholique de Louvain, Bruxelles, Belgium.
Cancer Causes Control. 2006 May;17(4):353-73. doi: 10.1007/s10552-005-0443-y.
The purpose of the present paper is to review cohort studies that examined the occurrence of prostate cancer in pesticide manufacturing workers in order to undertake a qualitative and quantitative evaluation of the risk as well as to assess the level of epidemiological evidence for each class of chemical compounds.
Following a systematic literature search, relative risk (RR) estimates for prostate cancer were extracted from 18 studies published between 1984 and 2004. All studies were summarised and evaluated for homogeneity and publication bias. As no significant heterogeneity was detected, combined RR estimators were calculated using a fixed effect model. Meta-analyses were performed both on the whole set of data and for each chemical class separately.
The meta-rate ratio estimate for all studies was 1.28 [95% confidence interval (CI) 1.05-1.58]. After stratification by specific chemical class, consistent increases in the risk of prostate cancer were found in all groups but statistical significance was found only for accidental or non-accidental exposure to phenoxy herbicides contaminated with dioxins and furans. There was no obvious indication of publication bias.
The overall meta-analysis provides additional quantitative evidence consistent with prior reviews focusing on other groups exposed to pesticides (farmers, pesticide applicators). The results again point to occupational exposure to pesticides as a possible risk factor for prostate cancer but the question of causality remains unanswered. Epidemiological evidence did not allow identifying a specific pesticide or chemical class that would be responsible for the increased risk but the strongest evidence comes from workers exposed to phenoxy herbicides possibly in relation with dioxin and/or furan contamination.
本文旨在回顾队列研究，这些研究调查了农药制造工人前列腺癌的发生情况，以便对风险进行定性和定量评估，并评估各类化合物的流行病学证据水平。
在进行系统的文献检索后，从1984年至2004年间发表的18项研究中提取了前列腺癌的相对风险（RR）估计值。对所有研究进行总结，并评估其同质性和发表偏倚。由于未检测到显著的异质性，使用固定效应模型计算合并RR估计值。对整个数据集以及每个化学类别分别进行荟萃分析。
所有研究的荟萃率比估计值为1.28[95%置信区间（CI）1.05 - 1.58]。按特定化学类别分层后，发现所有组前列腺癌风险均有一致增加，但仅在意外或非意外接触受二恶英和呋喃污染的苯氧基除草剂时具有统计学意义。没有明显的发表偏倚迹象。
总体荟萃分析提供了额外的定量证据，与之前针对其他接触农药人群（农民、农药施用者）的综述一致。结果再次表明职业接触农药可能是前列腺癌的一个风险因素，但因果关系问题仍未得到解答。流行病学证据无法确定导致风险增加的具体农药或化学类别，但最有力的证据来自可能与二恶英和/或呋喃污染有关的接触苯氧基除草剂的工人。
