Sassano Michele, Zhang Sirui, Kappil Elizabeth Maria, Zheng Tongzhang, Boffetta Paolo, Seyyedsalehi Monireh Sadat
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Brown University School of Public Health, Providence, RI, USA.
Cancer Epidemiol. 2025 Aug;97:102831. doi: 10.1016/j.canep.2025.102831. Epub 2025 Apr 25.
Recent literature suggests that exposure to per- and polyfluoroalkyl substances (PFAS) may be associated with increased cancer risk. However, evidence regarding their association with hematological cancers is inconclusive. Hence, we aimed to summarize findings of epidemiological studies on the issue. We conducted a systematic review by searching Pubmed and Scopus in April 2025 to identify studies on the association between PFAS and cancer types other than liver, kidney, and testis. We pooled relative risks (RRs) and 95 % confidence intervals (CIs) for the association between PFAS exposure and hematological cancers with restricted maximum likelihood method. Fourteen studies were included in the review. We found pooled RRs of 1.04 (95 % CI: 0.98, 1.10; I=12.0 %, p=0.332), 1.04 (95 % CI: 0.95, 1.14; I=0.0 %, p=0.523), and 1.06 (95 % CI: 0.94, 1.19; I=42.9 %, p=0.105) for the association between environmental or occupational PFAS exposure and total hematological cancer, leukemia, and lymphoma, respectively. As for types of lymphoma, environmental or occupational PFAS exposure was associated with incidence of non-Hodgkin lymphoma (RR: 1.15; 95 % CI: 1.01, 1.29; I=0.0 %, p=0.579), while no association with its mortality or with Hodgkin lymphoma was observed. The RR for the association between high serum levels of perfluorooctanoic acid and total hematological cancer was 1.13 (95 % CI: 0.72, 1.75; I=64.6 %%, p=0.023). Our results are suggestive of an association between PFAS exposure and non-Hodgkin lymphoma. Weak associations were also observed for total hematological cancer and leukemia among male individuals. Due to potential exposure misclassification in included studies, further evidence is needed to confirm our findings.
近期文献表明，接触全氟和多氟烷基物质（PFAS）可能与癌症风险增加有关。然而，关于它们与血液系统癌症之间关联的证据尚无定论。因此，我们旨在总结关于该问题的流行病学研究结果。2025年4月，我们通过检索PubMed和Scopus进行了一项系统综述，以确定关于PFAS与除肝脏、肾脏和睾丸之外的其他癌症类型之间关联的研究。我们采用受限最大似然法汇总了PFAS暴露与血液系统癌症之间关联的相对风险（RRs）和95%置信区间（CIs）。该综述纳入了14项研究。我们发现，环境或职业性PFAS暴露与血液系统癌症总数、白血病和淋巴瘤之间关联的汇总RR分别为1.04（95%CI：0.98，1.10；I=12.0%，p=0.332）、1.04（95%CI：0.95，1.14；I=0.0%，p=0.523）和1.06（95%CI：0.94，1.19；I=42.9%，p=0.105）。至于淋巴瘤类型，环境或职业性PFAS暴露与非霍奇金淋巴瘤的发病率相关（RR：1.15；95%CI：1.01，1.29；I=0.0%，p=0.579），而未观察到其与死亡率或霍奇金淋巴瘤之间存在关联。血清全氟辛酸水平高与血液系统癌症总数之间关联的RR为1.13（95%CI：0.72，1.75；I=64.6%，p=0.023）。我们的结果提示PFAS暴露与非霍奇金淋巴瘤之间存在关联。在男性个体中，还观察到血液系统癌症总数和白血病之间存在微弱关联。由于纳入研究中可能存在暴露误分类情况，需要更多证据来证实我们的发现。
