Sassano Michele, Seyyedsalehi Monireh Sadat, Kappil Elizabeth Maria, Zhang Sirui, Zheng Tongzhang, Boffetta Paolo
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Brown University School of Public Health, Providence, RI, USA.
Environ Res. 2025 Feb 1;266:120606. doi: 10.1016/j.envres.2024.120606. Epub 2024 Dec 11.
Recent evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of different cancer types, such as kidney and testicular cancers. Instead, evidence for lung, head and neck, and thyroid cancer is sparse. Hence, we aimed to summarize available literature on the topic. We searched Pubmed and Scopus in January 2024 to retrieve relevant studies and estimated pooled relative risks (RRs) and 95% confidence intervals (CIs) for lung, head and neck, and thyroid cancers according to PFAS exposure using restricted maximum likelihood method. Pooled RRs for occupational or environmental PFAS exposure were 1.20 (95% CI: 1.12-1.28; I = 0.0%, p = 0.9; n. studies = 9), 1.15 (95% CI: 0.96-1.37; I = 0.0%, p = 0.7; n. studies = 3), and 1.54 (95% CI: 0.86-2.78; I = 69.0%, p = 0.02; n. studies = 4) for lung, head and neck, and thyroid cancer, respectively. We did not find compelling evidence of publication bias for lung cancer (p = 0.3). Studies on statistically modelled serum PFAS levels did not support associations with these cancers. We found no positive associations between measured serum levels of 6 different types of PFAS and thyroid cancer. However, the pooled RR of two case-control studies nested within cohorts on the association between natural log-unit increase of perfluorooctanesulfonic acid (PFOS) and thyroid cancer was 1.51 (95% CI: 1.11-2.05; I = 21.1%, p = 0.3). PFAS exposure may be associated with lung and thyroid cancer. Due to the limited number of studies and their limitations, further prospective studies with appropriate account of co-exposure with other carcinogens and detailed exposure assessment are needed to establish causality of observed associations.
近期证据表明，接触全氟和多氟烷基物质（PFAS）可能会增加患不同类型癌症的风险，如肾癌和睾丸癌。相反，关于肺癌、头颈癌和甲状腺癌的证据则较为稀少。因此，我们旨在总结该主题的现有文献。我们于2024年1月在PubMed和Scopus上进行检索，以获取相关研究，并使用限制最大似然法根据PFAS暴露情况估计肺癌、头颈癌和甲状腺癌的合并相对风险（RRs）及95%置信区间（CIs）。职业性或环境性PFAS暴露的肺癌、头颈癌和甲状腺癌合并RRs分别为1.20（95%CI：1.12 - 1.28；I² = 0.0%，p = 0.9；研究数量n = 9）、1.15（95%CI：0.9 – 1.37；I² = 0.0%，p = 0.7；研究数量n = 3）和1.54（95%CI：0.86 – 2.78；I² = 69.0%，p = 0.02；研究数量n = 4）。我们未发现肺癌存在明显的发表偏倚证据（p = 0.3）。关于血清PFAS水平的统计模型研究并不支持其与这些癌症的关联。我们未发现6种不同类型PFAS的实测血清水平与甲状腺癌之间存在正相关。然而，两项嵌套在队列研究中的病例对照研究关于全氟辛烷磺酸（PFOS）自然对数单位增加与甲状腺癌关联的合并RR为1.51（95%CI：1.11 - 2.05；I² = 21.1%，p = 0.3）。PFAS暴露可能与肺癌和甲状腺癌有关。由于研究数量有限及其局限性，需要进一步开展前瞻性研究，适当考虑与其他致癌物的共同暴露情况，并进行详细的暴露评估，以确定所观察到关联的因果关系。
