Collatuzzo Giulia, Alicandro Gianfranco, Bertuccio Paola, Pelucchi Claudio, Bonzi Rossella, Palli Domenico, Ferraroni Monica, Ye Weimin, Plymoth Amelie, Zaridze David, Maximovich Dmitry, Aragones Nuria, Castaño-Vinyals Gemma, Vioque Jesus, Garcia de la Hera Manoli, Zhang Zuo-Feng, Hu Jinfu, Lopez-Carrillo Lizbeth, López-Cervantes Malaquías, Dalmartello Michela, Mu Lina, Ward Mary H, Rabkin Charles, Yu Guo-Pei, Camargo M Constanza, Curado Maria Paula, Lunet Nuno, Negri Eva, La Vecchia Carlo, Boffetta Paolo
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy.
J Epidemiol Community Health. 2022 Jul 13. doi: 10.1136/jech-2022-219074.
Peptic ulcer disease (PUD) and gastric cancer (GC) are more prevalent in individuals with low socioeconomic status (SES) and share several risk factors. The aim of this study was to investigate the mediating role of PUD in the association between established risk factors and GC.
We conducted a pooled analysis of 12 studies from the Stomach Cancer Pooling Project Consortium, including a total of 4877 GC cases and 11 808 controls. We explored the mediating role of PUD in the association between SES, tobacco smoking, heavy alcohol drinking and salt intake, and GC. Also, we assessed the ORs and 95% CIs of the risk factors and both PUD and GC.
PUD mediated 36% of the smoking effect mainly among men. Other risk factors were only slightly mediated by PUD (SES, 5.3%; heavy alcohol drinking, 3.3%; and salt intake, 2.5%). No significant difference was found when excluding PUD diagnosed within 2 years from GC.
Our study provides innovative information on the mechanism of stomach mucosal damage leading to PUD and GC, with respect to the effect of tobacco smoking in particular.
消化性溃疡病（PUD）和胃癌（GC）在社会经济地位（SES）较低的个体中更为普遍，且有若干共同的危险因素。本研究的目的是探讨PUD在既定危险因素与GC之间关联中的中介作用。
我们对来自胃癌合并项目联盟的12项研究进行了汇总分析，共纳入4877例GC病例和11808例对照。我们探讨了PUD在SES、吸烟、大量饮酒和盐摄入与GC之间关联中的中介作用。此外，我们评估了危险因素以及PUD和GC的比值比（OR）及95%置信区间（CI）。
PUD介导了吸烟效应的36%，主要发生在男性中。其他危险因素仅由PUD产生轻微的中介作用（SES为5.3%；大量饮酒为3.3%；盐摄入为2.5%）。排除在GC诊断前2年内确诊的PUD后，未发现显著差异。
我们的研究提供了关于导致PUD和GC的胃黏膜损伤机制的创新性信息，特别是关于吸烟的影响。
