Epidemiology Department, North Region Cancer Registry (RORENO), Portuguese Oncology Institute of Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.
EPIUnit-Institute of Public Health, University of Porto, Rua das Taipas 135, 4050-600, Porto, Portugal.
J Gastroenterol. 2018 Jan;53(1):37-51. doi: 10.1007/s00535-017-1375-5. Epub 2017 Aug 18.
There are marked differences in the etiology of the major histological types of esophageal cancer (EC)-squamous cell carcinomas (ESCC) and adenocarcinomas (EAC). This study aimed to summarize the current scientific knowledge on modifiable risk factors for EC, by histological type, through a systematic review of meta-analyses referenced in PubMed and ISI Web of Knowledge. We identified 100 meta-analyses on risk factors for ESCC (n = 54), EAC (n = 43), or EC (n = 51). ESCC risk significantly increased with alcohol and maté drinking, smoking, red and processed meat consumption and human papillomavirus infection, while it was negatively associated with body mass index and consumption of fruit, vegetables, white meat, folate, and some carotenoids. Cessation of drinking and smoking significantly reduced ESCC risk. For EAC, an increased risk was reported for smoking, body mass index, and red and processed meat consumption, while risk decreased with Helicobacter pylori infection, low/moderate alcohol drinking, physical activity, and consumption of fruit, vegetables, folate, fiber, beta-carotene, and vitamin C. Differences in results between meta-analyses and mechanisms underlying some of the associations found are discussed. This work reinforces the importance of a separate assessment of EC subtypes to allow for a proper evaluation of incidence trends and planning of prevention/control interventions.
食管癌(EC)的主要组织学类型(鳞癌和腺癌)的病因有明显差异。本研究旨在通过对 PubMed 和 ISI Web of Knowledge 中引用的荟萃分析进行系统综述,总结目前关于 EC 可改变危险因素的科学知识,按组织学类型进行分类。我们确定了 100 项关于 ESCC(n=54)、EAC(n=43)或 EC(n=51)危险因素的荟萃分析。ESCC 风险与酒精和马黛茶饮用、吸烟、红肉和加工肉消费以及人乳头瘤病毒感染显著相关,而与体重指数和水果、蔬菜、白肉、叶酸和一些类胡萝卜素的消费呈负相关。停止饮酒和吸烟可显著降低 ESCC 风险。对于 EAC,吸烟、体重指数和红肉和加工肉消费与风险增加相关,而幽门螺杆菌感染、低/中度饮酒、身体活动以及水果、蔬菜、叶酸、纤维、β-胡萝卜素和维生素 C 的消费与风险降低相关。荟萃分析之间的结果差异以及一些发现的关联背后的机制正在讨论中。这项工作强调了对 EC 亚型进行单独评估的重要性,以便对发病率趋势进行适当评估,并规划预防/控制干预措施。