Merhi M, Raynal H, Cahuzac E, Vinson F, Cravedi J P, Gamet-Payrastre L
UMR 1089 Xénobiotiques, INRA, 180 Chemin de Tournefeuille, Toulouse 31931, France.
Cancer Causes Control. 2007 Dec;18(10):1209-26. doi: 10.1007/s10552-007-9061-1. Epub 2007 Sep 15.
In this study we conducted a meta-analysis of 13 case-control studies that examined the occurrence of hematopoietic cancers in pesticide related occupations in order to undertake a qualitative and quantitative evaluation of a possible relationship.
Pubmed databases were searched for case-control studies published between 1990 and 2005 investigating the relation between hematopoietic cancers and occupational exposure to pesticides. Fixed and random effect meta-analysis models were used depending on the presence of heterogeneity between studies.
The overall meta-odds ratio obtained after pooling 44 ORs from 13 studies was 1.3 (95% CI: 1.3-1.5). We realized stratified analysis on three different types of hematopoietic cancers (non-Hodgkin lymphoma (NHL), leukemia and multiple myeloma). A significant increased risk of NHL was found (OR = 1.35; 95% CI = 1.2-1.5). Moreover, increased risks of Leukemia (OR = 1.35; 95% CI = 0.9-2) and multiple myeloma (OR = 1.16; 95% CI = 0.99-1.36) were also detected but these results were not statistically significant. Significant heterogeneity existed among the different studies and a publication bias was detected. Therefore, a meta-regression was carried out. Our results showed that a long period of exposure (more than 10 years) provided an increase in the risk of all hematopoietic cancers and for NHL by fractions of 2.18 (95% CI = 1.43-3.35) and 1.65 (95% CI = 1.08-2.51), respectively.
The overall meta-odds ratio suggests that there is a significantly positive association between occupational exposure to pesticides and all hematopoietic cancers as well as NHL. A major limitation of our meta-analysis is the lack of sufficient data about exposure information and other risk factors for hematopoietic cancer (genetic predisposition, ethnic origin, immunodepression...). In addition, data concerning specific subtypes of hematopoietic cancers are often confusing. Thus, future epidemiological studies should undertake a major effort to assess the identity and the level of pesticides exposure and should control for the most likely potential confounders.
在本研究中，我们对13项病例对照研究进行了荟萃分析，这些研究调查了农药相关职业中造血系统癌症的发生情况，以便对可能存在的关系进行定性和定量评估。
在PubMed数据库中搜索1990年至2005年间发表的病例对照研究，这些研究调查了造血系统癌症与职业性接触农药之间的关系。根据研究之间是否存在异质性，使用固定效应和随机效应荟萃分析模型。
汇总13项研究中的44个比值比后得到的总体荟萃比值比为1.3（95%可信区间：1.3 - 1.5）。我们对三种不同类型的造血系统癌症（非霍奇金淋巴瘤（NHL）、白血病和多发性骨髓瘤）进行了分层分析。发现NHL的风险显著增加（比值比 = 1.35；95%可信区间 = 1.2 - 1.5）。此外，还检测到白血病（比值比 = 1.35；95%可信区间 = 0.9 - 2）和多发性骨髓瘤（比值比 = 1.16；95%可信区间 = 0.99 - 1.36）的风险增加，但这些结果无统计学意义。不同研究之间存在显著异质性，并检测到发表偏倚。因此，进行了荟萃回归分析。我们的结果表明，长期暴露（超过10年）会使所有造血系统癌症以及NHL的风险分别增加2.18倍（95%可信区间 = 1.43 - 3.35）和1.65倍（95%可信区间 = 1.08 - 2.51）。
总体荟萃比值比表明，职业性接触农药与所有造血系统癌症以及NHL之间存在显著的正相关。我们荟萃分析的一个主要局限性是缺乏关于暴露信息和造血系统癌症其他风险因素（遗传易感性、种族、免疫抑制……）的足够数据。此外，关于造血系统癌症特定亚型的数据往往令人困惑。因此，未来的流行病学研究应大力评估农药暴露的种类和水平，并应控制最可能的潜在混杂因素。
