Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Environ Res. 2021 Jun;197:110887. doi: 10.1016/j.envres.2021.110887. Epub 2021 Feb 17.
The etiology of follicular lymphoma (FL), a common non-Hodgkin lymphoma subtype, is largely unknown.
We performed a systematic review and meta-analysis of observational studies examining the relationship between occupational exposures and FL risk.
We searched Ovid MEDLINE, Ovid EMBASE, and Web of Science for eligible observational studies examining job titles or occupational exposures prior to January 1, 2020. We performed a narrative synthesis and used random-effects models to generate meta-estimates of relative risk (RR) with 95% confidence intervals (95%CI) for exposures reported by three or more studies.
Fifty-eight studies were eligible. Ten cohort and 37 case-control studies quantified FL risk in relation to any exposure to one or more occupational groups or agents. Eight cohort and 19 case-control studies examined dose-response relationships. We found evidence of a positive association with increasing plasma concentration of dichlorodiphenyldichloroethylene (DDE; meta-RR = 1.51, 95%CI = 0.99, 2.31; I = 0.0%) and polychlorinated biphenyls (PCBs; meta-RR = 1.47, 95%CI = 0.97, 2.24; I = 8.6%). We observed a positive association with exposure to any solvent (meta-RR = 1.16, 95%CI = 1.00, 1.34; I = 0.0%) and chlorinated solvents (meta-RR = 1.35, 95%CI = 1.09, 1.68; I = 0.0%). Single studies reported a significant positive dose-response association for exposure to any pesticide, hexachlorobenzene, any organophosphate, diazinon, metolachlor, carbaryl, lindane, trichloroethylene, oils/greases, and extremely low-frequency magnetic fields. Job title-only analyses suggested increased risk for medical doctors and spray painters, and decreased risk for bakers and teachers. Overall, studies demonstrated low risk of bias, but most studies examined small numbers of exposed cases.
Current evidence indicates a positive association between FL and occupational exposure to DDE, PCBs, any solvent and chlorinated solvents. Our findings may help guide policies and practices on the safe use of solvents and inform models of lymphomagenesis. Future studies with larger sample sizes and comprehensive quantitative exposure measures may elucidate other avoidable carcinogenic exposures.
滤泡性淋巴瘤（FL）是一种常见的非霍奇金淋巴瘤亚型，其病因在很大程度上尚不清楚。
我们对观察性研究进行了系统评价和荟萃分析，以检查职业暴露与 FL 风险之间的关系。
我们在 Ovid MEDLINE、Ovid EMBASE 和 Web of Science 中检索了截至 2020 年 1 月 1 日之前研究工作标题或职业暴露的合格观察性研究。我们进行了叙述性综合，并使用随机效应模型生成了报告有三个或更多研究的暴露相对风险（RR）的荟萃估计值，以及 95%置信区间（95%CI）。
有 58 项研究符合条件。10 项队列研究和 37 项病例对照研究定量评估了与任何职业群体或职业因素暴露相关的 FL 风险。8 项队列研究和 19 项病例对照研究检查了剂量-反应关系。我们发现，随着二氯二苯二氯乙烯（DDE）血浆浓度的升高（meta-RR=1.51，95%CI=0.99，2.31；I=0.0%）和多氯联苯（PCBs）（meta-RR=1.47，95%CI=0.97，2.24；I=8.6%），FL 风险呈正相关。我们观察到与任何溶剂（meta-RR=1.16，95%CI=1.00，1.34；I=0.0%）和氯化溶剂（meta-RR=1.35，95%CI=1.09，1.68；I=0.0%）暴露的正相关。单研究报告了接触任何杀虫剂、六氯苯、任何有机磷农药、二嗪农、甲草胺、甲萘威、林丹、三氯乙烯、油/油脂和极低频磁场的显著正剂量-反应关联。职业标题分析表明，医生和喷漆工的风险增加，而面包师和教师的风险降低。总的来说，这些研究的偏倚风险较低，但大多数研究都检查了暴露病例数量较少的情况。
目前的证据表明，FL 与职业性接触 DDE、PCBs、任何溶剂和氯化溶剂之间存在正相关。我们的发现可能有助于指导有关溶剂安全使用的政策和实践，并为淋巴瘤发生模型提供信息。未来的研究需要更大的样本量和综合的定量暴露测量，以阐明其他可避免的致癌暴露。
