Hua Hongmei, Jiang Qiuping, Sun Pan, Xu Xing
Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Oncol. 2023 May 5;13:1132306. doi: 10.3389/fonc.2023.1132306. eCollection 2023.
BACKGROUND: The incidence of early-onset colorectal cancer (EOCRC), which means colorectal cancer diagnosed in patients under 50 years, has been increasing around the world. However, the etiology remains unclear. This study aims to identify risk factors for EOCRC. METHODS: This systematic review was conducted in PubMed, Embase, Scopus, and Cochrane Library databases from inception to November 25, 2022. We examined risk factors for EOCRC, including demographic factors, chronic conditions, and lifestyle behaviors or environmental factors. Random-effects/fixed-effects meta-analysis was adopted to combine effect estimates from published data. Study quality was evaluated with the Newcastle-Ottawa Scale (NOS). Statistical analysis was performed Revman5.3. Studies not suitable for the meta-analysis were analyzed by a systematic review. RESULTS: A total of 36 studies were identified for this review, and 30 studies were included in the meta-analysis. Significant risk factors for EOCRC included male (OR=1.20; 95% CI, 1.08-1.33), Caucasian (OR=1.44; 95% CI, 1.15-1.80), a family history of CRC (OR=5.90; 95% CI, 3.67-9.48), inflammatory bowel disease (OR=4.43; 95% CI, 4.05-4.84), obesity (OR=1.52; 95%CI, 1.20-1.91), overweight (OR=1.18; 95% CI, 1.12-1.25), triglycerides (OR=1.12; 95% CI, 1, 08-1.18), hypertension (OR=1.16; 95% CI, 1.12-1.21), metabolic syndrome (OR=1.29; 95% CI, 1.15-1.45), smoking (OR=1.44; 95% CI, 1.10-1.88), alcohol consumption (OR=1.41; 95% CI, 1.22-1.62), a sedentary lifestyle (OR=1.24; 95% CI, 1.05-1.46), red meat (OR=1.10; 95% CI, 1.04-1.16), processed meat (OR=1.53; 95% CI, 1.13-2.06), Western dietary patterns (OR=1.43; 95% CI, 1.18-1.73) and sugar-sweetened beverages (OR=1.55; 95% CI, 1.23-1.95). However, no statistical differences were found for hyperlipidemia and hyperglycemia. Vitamin D may be a protective factor (OR=0.72; 95% CI, 0.56-0.92). There was considerable heterogeneity among studies (I>60%). CONCLUSIONS: The study provides an overview of the etiology and risk factors of EOCRC. Current evidence can provide baseline data for risk prediction models specific to EOCRC and risk-tailored screening strategies.
背景：早发性结直肠癌（EOCRC）是指在50岁以下患者中诊断出的结直肠癌，其发病率在全球范围内呈上升趋势。然而，其病因仍不清楚。本研究旨在确定EOCRC的危险因素。 方法：本系统评价在PubMed、Embase、Scopus和Cochrane图书馆数据库中进行，检索时间从建库至2022年11月25日。我们研究了EOCRC的危险因素，包括人口统计学因素、慢性病以及生活方式行为或环境因素。采用随机效应/固定效应荟萃分析来合并已发表数据的效应估计值。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。使用Revman5.3进行统计分析。对不适合进行荟萃分析的研究进行系统评价分析。 结果：本综述共确定了36项研究，其中30项研究纳入了荟萃分析。EOCRC的显著危险因素包括男性（OR=1.20；95%CI，1.08 - 1.33）、白种人（OR=1.44；95%CI，1.15 - 1.80）、结直肠癌家族史（OR=5.90；95%CI，3.67 - 9.48）、炎症性肠病（OR=4.43；95%CI，4.05 - 4.84）、肥胖（OR=1.52；95%CI，1.20 - 1.91）、超重（OR=1.18；95%CI，1.12 - 1.25）、甘油三酯（OR=1.12；95%CI，1.08 - 1.18）、高血压（OR=1.16；95%CI，1.12 - 1.21）、代谢综合征（OR=1.29；95%CI，1.15 - 1.45）、吸烟（OR=1.44；95%CI，1.10 - 1.88）、饮酒（OR=1.41；95%CI，1.22 - 1.62）、久坐的生活方式（OR=1.24；95%CI，1.05 - 1.46）、红肉（OR=1.10；95%CI，1.04 - 1.16）、加工肉类（OR=1.53；95%CI，1.13 - 2.06）、西方饮食模式（OR=1.43；95%CI，1.18 - 1.73）和含糖饮料（OR=1.55；95%CI，1.23 - 1.95）。然而，高脂血症和高血糖未发现统计学差异。维生素D可能是一个保护因素（OR=0.72；95%CI，0.56 - 0.92）。研究间存在相当大的异质性（I>60%）。 结论：本研究概述了EOCRC的病因和危险因素。现有证据可为特定于EOCRC的风险预测模型和风险定制筛查策略提供基线数据。
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