Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Pediatrics, Perlman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Clin Exp Allergy. 2020 Feb;50(2):147-159. doi: 10.1111/cea.13537. Epub 2019 Dec 20.
While chronic inflammation is a well-established risk factor for malignancy, studies evaluating the relationship between allergic inflammation and cancer have revealed conflicting results. Here, we aimed to assess the association between allergic inflammation in the lung (asthma), skin (eczema) or oesophagus (eosinophilic oesophagitis; EoE) and cancer at the organ site.
We conducted a systematic review of the literature to identify observational studies (case-control, cohort and cross-sectional) evaluating the association between asthma and lung cancer, eczema and skin cancer, or EoE and oesophageal cancer. Random-effects meta-analysis was performed to define pooled estimates of effects.
PubMed, EMBASE and Web of Science.
Included studies evaluated the incidence of cancer.
Thirty-two studies met the inclusion criteria, 27 in the lung, four in the skin and one in the oesophagus. Meta-analysis of the three studies with prospective data collection of asthma diagnosis revealed a positive association with incident lung cancer (OR 1.27, 95% CI 1.09-1.44); however, this result was not consistently supported by the larger dataset of retrospective studies (OR 1.37, 95% CI 0.90-1.83). Overall, studies in the lung displayed significant heterogeneity (I 98%, P < .0001), but no significant effect modification on the association between asthma and lung cancer was identified for the variables of sex, smoking or study design. Meta-analysis could not be applied to the four papers reviewed in the skin, but three suggested an association between eczema and non-melanoma skin cancer, while the remaining study failed to identify an association between melanoma and eczema. A single study meeting inclusion criteria showed no association between EoE and oesophageal malignancy.
The current data cannot exclude the possibility of an association between atopy and malignancy the lung, skin and oesophagus. The relationship between allergy and cancer should be explored further in prospective studies that any association identified between these conditions has the potential for significant public health implications.
虽然慢性炎症是恶性肿瘤的一个公认的危险因素，但评估过敏炎症与癌症之间关系的研究结果却存在矛盾。在这里，我们旨在评估肺部（哮喘）、皮肤（湿疹）或食管（嗜酸性食管炎；EoE）过敏炎症与特定器官部位癌症之间的关联。
我们对文献进行了系统综述，以确定评估哮喘与肺癌、湿疹与皮肤癌或 EoE 与食管癌之间关联的观察性研究（病例对照、队列和横断面研究）。采用随机效应荟萃分析来确定效应的汇总估计值。
PubMed、EMBASE 和 Web of Science。
纳入的研究评估了癌症的发病率。
32 项研究符合纳入标准，其中 27 项研究涉及肺部，4 项研究涉及皮肤，1 项研究涉及食管。对三项前瞻性收集哮喘诊断数据的研究进行荟萃分析显示，与肺癌发病风险呈正相关（OR 1.27，95%CI 1.09-1.44）；然而，这一结果并未得到回顾性研究的更大数据集的一致支持（OR 1.37，95%CI 0.90-1.83）。总体而言，肺部研究显示出显著的异质性（I 98%，P<.0001），但未发现哮喘与肺癌之间的关联存在性别、吸烟或研究设计等变量的显著效应修饰。无法对综述中涉及的 4 篇关于皮肤的论文进行荟萃分析，但有 3 篇论文表明湿疹与非黑色素瘤皮肤癌之间存在关联，而其余研究未能确定湿疹与黑色素瘤之间的关联。仅有一项符合纳入标准的研究表明，嗜酸性食管炎与食管恶性肿瘤之间无关联。
目前的数据不能排除特应性与肺部、皮肤和食管恶性肿瘤之间存在关联的可能性。应在前瞻性研究中进一步探讨过敏与癌症之间的关系，因为任何在这些疾病之间确定的关联都有可能对公共卫生产生重大影响。
