Raymond L, Bouchardy C
Registre genevois des tumeurs, Genève, Suisse.
Bull Cancer. 1990;77(1):47-68.
The main case control studies and over 30 cohort studies of pancreatic cancer, performed during the period 1973-1988 are reviewed. For each type of risk factor a table is given which summarizes the conclusions of the various studies. The multifactorial etiology of this cancer is reflected by the number of different exposures studied. In our opinion, the effects of tobacco are indisputable even though they have not been systematically described in all studies. Cigarette smoking is associated with two-fold increase in risk. The effect of different forms of smoking, such as filter utilization, pipe, colour of tobacco, etc. on the risk are unclear. The effect of alcohol is less important although this needs to be confirmed. Tobacco use was not controlled in many studies where a positive results was obtained for alcohol. The same confounding effect has perhaps biased the results of several studies carried out for coffee drinkers. While not definitively confirmed, the elevated risk associated with coffee drinking appears to be plausible. Results on other dietary factors have not been widely reported. However, a positive association has been found for consumption of meat and fat and a negative one for vegetables and fruits. In some cases, these results are amplified by a dose-response effect. Further nutritional studies are required in order to resolve this question. Previous medical conditions have also been considered, in particular diseases of the pancreas, i.e. diabetes mellitus and pancreatitis. The results are not consistent, as causes and effects are not easy to detect. However, positive results for diabetes mellitus are more convincing than those for other conditions. Potential effects of work-related exposure have been analysed by many researchers although no firm conclusions can be drawn upon review of those results. Among the suspected risks, one has to consider the chemical industry and industrial exposure in oil refinery, aluminium reduction, and coke transformation. Occupations involving contact with dyes, paint and thinners could also be in the risk group.
回顾了1973年至1988年期间开展的主要胰腺癌病例对照研究以及30多项队列研究。针对每种风险因素给出了一个表格，总结了各项研究的结论。该癌症的多因素病因通过所研究的不同暴露因素数量得以体现。我们认为，尽管并非所有研究都对烟草的影响进行了系统描述，但其影响是无可争议的。吸烟会使风险增加两倍。不同形式的吸烟，如使用过滤嘴、抽烟斗、烟草颜色等对风险的影响尚不清楚。酒精的影响相对较小，不过这一点有待证实。在许多得出酒精有阳性结果的研究中，未对烟草使用进行控制。同样的混杂效应可能也使针对咖啡饮用者开展的几项研究结果产生了偏差。虽然尚未得到明确证实，但与咖啡饮用相关的风险升高似乎是合理的。关于其他饮食因素的结果尚未广泛报道。然而，已发现肉类和脂肪的摄入与胰腺癌呈正相关，而蔬菜和水果的摄入与胰腺癌呈负相关。在某些情况下，这些结果会因剂量反应效应而增强。需要进一步开展营养研究以解决这一问题。既往疾病状况也已被纳入考量，尤其是胰腺疾病，即糖尿病和胰腺炎。结果并不一致，因为因果关系不易察觉。然而，糖尿病的阳性结果比其他疾病的结果更具说服力。许多研究人员分析了与工作相关暴露的潜在影响，不过对这些结果进行审查后无法得出确凿结论。在可疑风险中，必须考虑化工行业以及炼油、炼铝和焦炭转化过程中的工业暴露。涉及接触染料、油漆和稀释剂的职业也可能属于风险群体。
