College of Public Health, University of South Florida, Tampa, Florida, USA.
Department of Clinical Sciences and Community Health, University of Milan, Milan.
Eur J Cancer Prev. 2022 May 1;31(3):260-269. doi: 10.1097/CEJ.0000000000000703.
Prior epidemiologic studies on the association between diabetes and gastric cancer risk provided inconclusive findings, while traditional, aggregate data meta-analyses were characterized by high between-study heterogeneity.
To investigate the association between type 2 diabetes and gastric cancer using data from the 'Stomach Cancer Pooling (StoP) Project', an international consortium of more than 30 case-control and nested case-control studies, which is large and provides harmonized definition of participants' characteristics across individual studies. The data have the potential to minimize between-study heterogeneity and provide greater statistical power for subgroup analysis.
We included 5592 gastric cancer cases and 12 477 controls from 14 studies from Europe, Asia, North America, and South America in a two-stage individual-participant data meta-analysis. Random-effect models were used to estimate summary odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) by pooling study-specific ORs.
We did not find an overall association between diabetes and gastric cancer (pooled OR = 1.01, 95% CI, 0.94-1.07). However, the risk of cardia gastric cancer was significantly higher among individuals with type 2 diabetes (OR = 1.16, 95% CI, 1.02-1.33). There was no association between diabetes and gastric cancer risk in strata of Helicobacter pylori infection serostatus, age, sex, BMI, smoking status, alcohol consumption, fruit/vegetable intake, gastric cancer histologic type, and source of controls.
This study provides additional evidence that diabetes is unrelated to gastric cancer overall but may be associated with excess cardia gastric cancer risk.
先前关于糖尿病与胃癌风险之间关联的流行病学研究结果并不一致，而传统的综合数据分析存在高度的研究间异质性。
利用来自“胃癌汇集（StoP）项目”的个体参与者数据进行荟萃分析，该项目是一个由 30 多个病例对照和巢式病例对照研究组成的国际联盟，规模庞大，可协调个体研究中参与者特征的定义，以调查 2 型糖尿病与胃癌之间的关联。这些数据有可能最大限度地减少研究间异质性，并为亚组分析提供更大的统计效力。
我们对来自欧洲、亚洲、北美和南美的 14 项研究中的 5592 例胃癌病例和 12477 例对照进行了两阶段个体参与者数据荟萃分析。使用随机效应模型，通过汇总研究特异性比值比（OR）来估计汇总 OR 及其相应的 95%置信区间（CI）。
我们未发现糖尿病与胃癌之间存在总体关联（汇总 OR=1.01，95%CI，0.94-1.07）。然而，2 型糖尿病患者发生贲门胃癌的风险显著升高（OR=1.16，95%CI，1.02-1.33）。在幽门螺杆菌感染血清状态、年龄、性别、BMI、吸烟状况、饮酒、水果/蔬菜摄入量、胃癌组织学类型和对照来源等分层中，糖尿病与胃癌风险之间均无关联。
本研究提供了额外的证据表明，糖尿病与总体胃癌无关，但可能与贲门胃癌风险增加有关。
