Suppr超能文献

子宫内膜癌的危险因素:文献综述的伞状评价。

Risk factors for endometrial cancer: An umbrella review of the literature.

机构信息

Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, United Kingdom.

Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.

出版信息

Int J Cancer. 2019 Oct 1;145(7):1719-1730. doi: 10.1002/ijc.31961. Epub 2019 Feb 20.

Abstract

Although many risk factors could have causal association with endometrial cancer, they are also prone to residual confounding or other biases which could lead to over- or underestimation. This umbrella review evaluates the strength and validity of evidence pertaining risk factors for endometrial cancer. Systematic reviews or meta-analyses of observational studies evaluating the association between non-genetic risk factors and risk of developing or dying from endometrial cancer were identified from inception to April 2018 using PubMed, the Cochrane database and manual reference screening. Evidence was graded strong, highly suggestive, suggestive or weak based on statistical significance of random-effects summary estimate, largest study included, number of cases, between-study heterogeneity, 95% prediction intervals, small study effects, excess significance bias and sensitivity analysis with credibility ceilings. We identified 171 meta-analyses investigating associations between 53 risk factors and endometrial cancer incidence and mortality. Risk factors were categorised: anthropometric indices, dietary intake, physical activity, medical conditions, hormonal therapy use, biochemical markers, gynaecological history and smoking. Of 127 meta-analyses including cohort studies, three associations were graded with strong evidence. Body mass index and waist-to-hip ratio were associated with increased cancer risk in premenopausal women (RR per 5 kg/m 1.49; CI 1.39-1.61) and for total endometrial cancer (RR per 0.1unit 1.21; CI 1.13-1.29), respectively. Parity reduced risk of disease (RR 0.66, CI 0.60-0.74). Of many proposed risk factors, only three had strong association without hints of bias. Identification of genuine risk factors associated with endometrial cancer may assist in developing targeted prevention strategies for women at high risk.

摘要

虽然许多风险因素可能与子宫内膜癌有因果关系,但它们也容易受到残余混杂因素或其他偏倚的影响,从而导致高估或低估。本伞式评价评估了与子宫内膜癌风险相关的非遗传风险因素的证据强度和有效性。从建立到 2018 年 4 月,使用 PubMed、Cochrane 数据库和手动参考筛选,系统地综述或荟萃分析了评估非遗传风险因素与发展或死于子宫内膜癌风险之间关联的观察性研究。根据随机效应汇总估计的统计学意义、纳入的最大研究、病例数、研究间异质性、95%预测区间、小研究效应、过度显著性偏差和可信度上限的敏感性分析,证据被评为强、高度提示、提示或弱。我们确定了 171 项荟萃分析,研究了 53 个风险因素与子宫内膜癌发病率和死亡率之间的关系。风险因素分为:人体测量指数、饮食摄入、体力活动、医疗状况、激素治疗使用、生化标志物、妇科病史和吸烟。在 127 项包括队列研究的荟萃分析中,有 3 项被评为具有强有力的证据。体重指数和腰臀比与绝经前妇女的癌症风险增加相关(每增加 5kg/m 2 的 RR 为 1.49;95%CI 为 1.39-1.61)和总子宫内膜癌(每增加 0.1 单位的 RR 为 1.21;95%CI 为 1.13-1.29)。生育次数减少了疾病的风险(RR 为 0.66,95%CI 为 0.60-0.74)。在许多提出的风险因素中,只有三个有强烈的关联,没有暗示偏倚。确定与子宫内膜癌相关的真正风险因素可能有助于为高风险妇女制定有针对性的预防策略。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验