Department of Oncology, Georgetown University School of Medicine, Washington, DC.
Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina.
Eur J Cancer Prev. 2021 Mar 1;30(2):161-170. doi: 10.1097/CEJ.0000000000000597.
Epidemiologic evidence regarding association of ovarian cancer risk with blood lipid level and hyperlipidemia is inconsistent. We aimed to synthesize available epidemiologic studies to disentangle associations of cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and hyperlipidemia with ovarian cancer risk. We searched PubMed, EMBASE, and Web of Science for eligible studies. A random-effects model was applied for synthesis. Heterogeneity was evaluated by a Chi-squared test for the Cochran Q statistic and the I-squared value. Subgroup analysis was conducted by design, study locale, and ovarian cancer case number. Sensitivity analysis was conducted for studies adjusting for certain covariates or with superior quality. To explore the potential dose-response relationship, we further synthesized effect measures of moderate levels of cholesterol, triglycerides, HDL-C, and LDL-C. Twelve studies (five cohort and seven case-control studies) were included. In primary meta-analysis, the synthesized risk ratio (RRpool) and 95% confidence interval (CI) suggested that high cholesterol was associated with an increased ovarian cancer risk (RRpool 1.22, 95% CI 1.01-1.48, Cochran P value: 0.40, I2: 0.5%). High HDL-C was associated with a lower ovarian cancer risk (RRpool 0.61, 95% CI 0.40-0.94, Cochran P value: 0.06, I2: 63.7%). We obtained nonsignificant associations for other exposures. Subgroup and sensitivity analyses yielded consistent results as the primary analysis. Only cholesterol showed marginally significant association in synthesis using moderate exposure levels (RRpool 1.18, 95% CI 0.99-1.42, Cochran P value: 0.51, I2: 0.0%). Our study suggests that high blood cholesterol is associated with an increased ovarian cancer risk, whereas the etiological significance of other exposures deserves more investigations.
关于卵巢癌风险与血脂水平和高脂血症之间的关联的流行病学证据并不一致。我们旨在综合现有的流行病学研究，以阐明胆固醇、甘油三酯、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和高脂血症与卵巢癌风险之间的关联。我们在 PubMed、EMBASE 和 Web of Science 中搜索了符合条件的研究。采用随机效应模型进行综合分析。使用 Cochran Q 统计量和 I 平方值评估异质性。通过设计、研究地点和卵巢癌病例数进行亚组分析。对调整了某些协变量或质量较高的研究进行敏感性分析。为了探索潜在的剂量-反应关系，我们进一步综合了中等水平胆固醇、甘油三酯、HDL-C 和 LDL-C 的效应度量。纳入了 12 项研究（5 项队列研究和 7 项病例对照研究）。在主要的荟萃分析中，综合风险比（RRpool）和 95%置信区间（CI）表明高胆固醇与卵巢癌风险增加相关（RRpool 1.22，95%CI 1.01-1.48，Cochran P 值：0.40，I2：0.5%）。高 HDL-C 与较低的卵巢癌风险相关（RRpool 0.61，95%CI 0.40-0.94，Cochran P 值：0.06，I2：63.7%）。我们没有发现其他暴露的显著关联。亚组和敏感性分析的结果与主要分析一致。只有胆固醇在使用中等暴露水平的综合分析中显示出略微显著的关联（RRpool 1.18，95%CI 0.99-1.42，Cochran P 值：0.51，I2：0.0%）。我们的研究表明，高血胆固醇与卵巢癌风险增加有关，而其他暴露的病因学意义值得进一步研究。
