Kennedy Oliver John, Roderick Paul, Buchanan Ryan, Fallowfield Jonathan Andrew, Hayes Peter Clive, Parkes Julie
Primary Care and Population Sciences Faculty of Medicine, University of Southampton, Southampton, UK.
MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
BMJ Open. 2017 May 9;7(5):e013739. doi: 10.1136/bmjopen-2016-013739.
To examine the association between coffee, including caffeinated and decaffeinated coffee, with hepatocellular carcinoma (HCC) and assess the influence of HCC aetiology and pre-existing liver disease.
We performed a systematic review and meta-analysis. We calculated relative risks (RRs) of HCC according to caffeinated and decaffeinated coffee consumption using a random-effects dose-response meta-analysis. We tested for modification of the effect estimate by HCC aetiology and pre-existing liver disease. We judged the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
We found 18 cohorts, involving 2 272 642 participants and 2905 cases, and 8 case-control studies, involving 1825 cases and 4652 controls. An extra two cups per day of coffee was associated with a 35% reduction in the risk of HCC (RR 0.65, 95% CI 0.59 to 0.72). The inverse association was weaker for cohorts (RR 0.71, 95% CI 0.65 to 0.77), which were generally of higher quality than case-control studies (RR 0.53, 95% CI 0.41 to 0.69). There was evidence that the association was not significantly altered by stage of liver disease or the presence/absence of high alcohol consumption, high body mass index, type 2 diabetes mellitus, smoking, or hepatitis B and C viruses. An extra two cups of caffeinated and decaffeinated coffee (2 and 3 cohort studies, respectively) were associated with reductions of 27% (RR 0.73, 95% CI 0.63 to 0.85) and 14% (RR 0.86, 95% CI 0.74 to 1.00) in the risk of HCC. However, due to a lack of randomised controlled trials, potential publication bias and there being no accepted definition of coffee, the quality of evidence under the GRADE criteria was 'very low'.
Increased consumption of caffeinated coffee and, to a lesser extent, decaffeinated coffee are associated with reduced risk of HCC, including in pre-existing liver disease. These findings are important given the increasing incidence of HCC globally and its poor prognosis.
研究包括含咖啡因咖啡和脱咖啡因咖啡在内的咖啡与肝细胞癌（HCC）之间的关联，并评估HCC病因和既往肝病的影响。
我们进行了一项系统评价和荟萃分析。我们使用随机效应剂量反应荟萃分析，根据含咖啡因和脱咖啡因咖啡的摄入量计算HCC的相对风险（RRs）。我们测试了HCC病因和既往肝病对效应估计值的修正情况。我们使用推荐分级评估、制定和评价（GRADE）标准来判断证据质量。
我们发现了18个队列研究，涉及2272642名参与者和2905例病例，以及8个病例对照研究，涉及1825例病例和4652名对照。每天多喝两杯咖啡与HCC风险降低35%相关（RR 0.65，95%CI 0.59至0.72）。队列研究中的反向关联较弱（RR 0.71，95%CI 0.65至0.77），队列研究的质量通常高于病例对照研究（RR 0.53，95%CI 0.41至0.69）。有证据表明，肝病分期、是否大量饮酒、高体重指数、2型糖尿病、吸烟或乙型和丙型肝炎病毒的存在与否，均未显著改变这种关联。额外多喝两杯含咖啡因咖啡和脱咖啡因咖啡（分别有2个和3个队列研究）与HCC风险降低27%（RR 0.73，95%CI 0.63至0.85）和14%（RR 0.86，95%CI 0.74至1.00）相关。然而，由于缺乏随机对照试验、潜在的发表偏倚以及没有公认的咖啡定义，根据GRADE标准，证据质量为“非常低”。
增加含咖啡因咖啡的摄入量，以及在较小程度上增加脱咖啡因咖啡的摄入量，与降低HCC风险相关，包括在既往有肝病的情况下。鉴于全球HCC发病率不断上升及其预后不良，这些发现具有重要意义。
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