Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
Division of Medical Oncology, Departmentof Oncology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
Prostate Cancer Prostatic Dis. 2022 Sep;25(3):453-462. doi: 10.1038/s41391-022-00570-1. Epub 2022 Jul 5.
Most of the epidemiological data on prostate cancer risk factors come from high-income countries (HIC). Reducing exposure to prostate cancer modifiable risk factors may significantly lower PCa morbidity and mortality in LIC and MIC. The objective of this study was to summarize the evidence on modifiable risk factors (RFs) for PCa in LIC and lower-middle-income countries (LMIC).
We conducted a systematic search on MEDLINE, EMBASE, and Global Health databases. We selected case-control and cohort studies from 2010 onwards that studied modifiable RFs for PCa in LIC and LMIC with a population of 30 million or more, as defined by the World Bank in January 2021. Risk of bias was assessed by the Ottawa-Newcastle tool. Individual study estimates were pooled when estimates were available for at least two studies.
5740 studies were initially identified; 16 studies met inclusion criteria. All were case-control studies except one retrospective cohort study. Higher fat intake was associated with a higher risk of PCa incidence with an odds ratio (OR) of 3.13 (95% CI 1.33-7.33). Higher vegetable intake (OR 0.48, 95% CI 0.24-0.97) and tea consumption (OR 0.51, 95% CI 0.32-0.83) were associated with a lower risk for PCa. There was no association between fruits, fish, and chicken consumption and risk of PCa. Alcohol consumption, smoking, red meat intake, and a BMI ≥ 25-30 kg/m showed a trend towards an increased risk, although these were not statistically significant.
In LIC and LMIC, high fat intake was associated with higher risk of PCa while a diet rich in vegetables and tea intake was associated with a lower risk. Future prospective studies will be important to elucidate whether other modifiable risk factors for PCa specific to LIC and LMIC can be identified to inform impactful and cost-effective preventive strategies in these countries.
大多数关于前列腺癌危险因素的流行病学数据来自高收入国家（HIC）。减少前列腺癌可改变的危险因素的暴露可能会显著降低LIC 和 MIC 中的前列腺癌发病率和死亡率。本研究的目的是总结 LIC 和中低收入国家（LMIC）中前列腺癌可改变危险因素（RF）的证据。
我们在 MEDLINE、EMBASE 和全球卫生数据库上进行了系统搜索。我们选择了 2010 年以后的病例对照和队列研究，这些研究在 LIC 和 LMIC 中研究了前列腺癌的可改变 RF，这些国家的人口为 3000 万或以上，这是 2021 年 1 月世界银行定义的。使用渥太华-纽卡斯尔工具评估偏倚风险。当至少有两项研究提供估计值时，会汇总个别研究的估计值。
最初确定了 5740 项研究；16 项研究符合纳入标准。除了一项回顾性队列研究外，所有研究都是病例对照研究。较高的脂肪摄入量与前列腺癌发病率的风险增加相关，比值比（OR）为 3.13（95%CI 1.33-7.33）。较高的蔬菜摄入量（OR 0.48，95%CI 0.24-0.97）和茶摄入量（OR 0.51，95%CI 0.32-0.83）与前列腺癌风险降低相关。水果、鱼类和鸡肉的摄入量与前列腺癌风险之间没有关联。饮酒、吸烟、摄入红肉和 BMI≥25-30kg/m2 显示出风险增加的趋势，尽管这些趋势没有统计学意义。
在 LIC 和 LMIC，高脂肪摄入量与前列腺癌风险增加相关，而富含蔬菜和茶的饮食与风险降低相关。未来的前瞻性研究将很重要，可以阐明是否可以确定 LIC 和 LMIC 特有的其他前列腺癌可改变危险因素，以便为这些国家制定有影响力和具有成本效益的预防策略。
