Kim Seungwon, Kim Min Seo, Kwon Yeongkeun, Min Jae-Seok, Alromi Ahmad, Kim Jong Yeob, Kim Jueon, Shin Jae Il, Yon Dong Keon, Chu Yuhyeon, Park Sungsoo
Korea University Anam Hospital, Seoul, Korea.
Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea.
J Gastric Cancer. 2025 Apr;25(2):285-302. doi: 10.5230/jgc.2025.25.e16.
Despite extensive research on gastric cancer (GC), efforts to consolidate the numerous associations between possible factors and GC risk remain lacking. This systematic review aimed to provide an overview of potential GC-associated pairs.
We systematically searched PubMed, Embase, and Cochrane databases, from their inception to April 23, 2022, for eligible systematic reviews and meta-analyses to investigate the association between any possible factors and GC risk. After the inclusion of 75 systematic reviews and meta-analyses, 117 association pairs were examined. We reanalyzed the included meta-analyses and produced effect estimates using uniform analytical models. The certainty of the evidence for each association pair was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.
Iatrogenic factors, including antibacterial drugs, were associated with an increased risk of GC. Epstein-Barr virus and infections were also associated with an increased risk of GC, while human T-lymphotropic virus type 1 (HTLV-1) infections were associated with a reduced risk. Dietary habit was a major factor influencing moderate to high GRADE associations. Positive associations were observed for heavy alcohol consumption (relative risk [RR], 1.13; 95% confidence interval [CI], 1.06-1.12), refined grain consumption (RR, 1.36; 95% CI, 1.21-1.53), and habitual salt intake (RR, 1.41; 95% CI, 1.04-1.91).
The associations between GC risk and dietary and nutritional factors were considerably heterogeneous, whereas other factors, such as lifestyle and iatrogenic and environmental exposures, were consistent across regions. Therefore, dietary interventions for GC prevention should be tailored specific to regions.
PROSPERO Identifier: CRD42020209817.
尽管对胃癌（GC）进行了广泛研究，但在整合可能因素与GC风险之间的众多关联方面仍缺乏努力。本系统评价旨在概述潜在的GC相关因素对。
我们系统检索了PubMed、Embase和Cochrane数据库，从建库至2022年4月23日，以查找 eligible 系统评价和Meta分析，以研究任何可能因素与GC风险之间的关联。纳入75项系统评价和Meta分析后，对117个关联因素对进行了检查。我们重新分析了纳入的Meta分析，并使用统一分析模型得出效应估计值。使用推荐分级、评估、制定和评价（GRADE）标准评估每个关联因素对的证据确定性。
包括抗菌药物在内的医源性因素与GC风险增加相关。爱泼斯坦-巴尔病毒和感染也与GC风险增加相关，而1型人类嗜T淋巴细胞病毒（HTLV-1）感染与风险降低相关。饮食习惯是影响中到高GRADE关联的主要因素。观察到重度饮酒（相对风险[RR]，1.13；95%置信区间[CI]，1.06 - 1.12）、精制谷物消费（RR，1.36；95%CI，1.21 - 1.53）和习惯性盐摄入（RR，1.41；95%CI，1.04 - 1.91）呈正相关。
GC风险与饮食和营养因素之间的关联存在很大异质性，而其他因素，如生活方式、医源性和环境暴露，在各地区是一致的。因此，预防GC的饮食干预应针对不同地区进行定制。
PROSPERO标识符：CRD42020209817 。
