Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia.
Eur Urol. 2023 Aug;84(2):176-190. doi: 10.1016/j.eururo.2023.03.029. Epub 2023 May 16.
Bladder cancer (BC) is common worldwide and poses a significant public health challenge. External risk factors and the wider exposome (totality of exposure from external and internal factors) contribute significantly to the development of BC. Therefore, establishing a clear understanding of these risk factors is the key to prevention.
To perform an up-to-date systematic review of BC's epidemiology and external risk factors.
Two reviewers (I.J. and S.O.) performed a systematic review using PubMed and Embase in January 2022 and updated it in September 2022. The search was restricted to 4 yr since our previous review in 2018.
Our search identified 5177 articles and a total of 349 full-text manuscripts. GLOBOCAN data from 2020 revealed an incidence of 573 000 new BC cases and 213 000 deaths worldwide in 2020. The 5-yr prevalence worldwide in 2020 was 1 721 000. Tobacco smoking and occupational exposures (aromatic amines and polycyclic aromatic hydrocarbons) are the most substantial risk factors. In addition, correlative evidence exists for several risk factors, including specific dietary factors, imbalanced microbiome, gene-environment risk factor interactions, diesel exhaust emission exposure, and pelvic radiotherapy.
We present a contemporary overview of the epidemiology of BC and the current evidence for BC risk factors. Smoking and specific occupational exposures are the most established risk factors. There is emerging evidence for specific dietary factors, imbalanced microbiome, gene-external risk factor interactions, diesel exhaust emission exposure, and pelvic radiotherapy. Further high-quality evidence is required to confirm initial findings and further understand cancer prevention.
Bladder cancer is common, and the most substantial risk factors are smoking and workplace exposure to suspected carcinogens. On-going research to identify avoidable risk factors could reduce the number of people who get bladder cancer.
膀胱癌（BC）在全球范围内较为常见，是一项重大的公共卫生挑战。外在风险因素和更广范围的暴露组（来自内外因素的暴露总和）对 BC 的发生有重要影响。因此，明确了解这些风险因素是预防的关键。
对 BC 的流行病学和外在风险因素进行最新的系统综述。
两位审查员（I.J.和 S.O.）于 2022 年 1 月使用 PubMed 和 Embase 进行了系统综述，并于 2022 年 9 月进行了更新。检索范围限制为自 2018 年我们上次综述以来的 4 年。
我们的检索共确定了 5177 篇文章和总共 349 篇全文。2020 年 GLOBOCAN 数据显示，2020 年全球新发病例 57.3 万例，死亡 21.3 万例。2020 年全球 5 年患病率为 172.1 万例。吸烟和职业暴露（芳香胺和多环芳烃）是最重要的风险因素。此外，还有一些风险因素的相关性证据，包括特定的饮食因素、失衡的微生物组、基因-环境风险因素相互作用、柴油废气排放暴露和盆腔放疗。
我们介绍了 BC 流行病学和当前 BC 风险因素的最新概述。吸烟和特定的职业暴露是最确定的风险因素。特定的饮食因素、失衡的微生物组、基因-外部风险因素相互作用、柴油废气排放暴露和盆腔放疗的证据正在出现。需要进一步的高质量证据来确认初始发现并进一步了解癌症预防。
膀胱癌较为常见，最重要的风险因素是吸烟和工作场所接触可疑致癌物。正在进行的识别可避免风险因素的研究可能会减少膀胱癌患者的数量。
