Kasperczyk E, Lesicka M, Reszka E
Department of Translational Research, Nofer Institute of Occupational Medicine, Lodz, Poland.
Department of Translational Research, Nofer Institute of Occupational Medicine, Lodz, Poland.
Actas Urol Esp (Engl Ed). 2025 Jul-Aug;49(6):501789. doi: 10.1016/j.acuroe.2025.501789. Epub 2025 Jun 5.
To summarize the key findings of occupational exposures during aluminum production in cohort studies on bladder cancer published between 1979 and 2023.
This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO. Study quality was evaluated using the Newcastle-Ottawa scale.
The literature search identified 24 cohort studies examining the standardized incidence (SIR) and mortality ratios (SMR) of bladder cancer among aluminum production workers. Five of the 13 studies examined SIR (95% CI) and three of the 16 studies that examined SMR (95% CI) reported a statistically significant increased risk of bladder cancer among aluminum production workers. The highest SIR was recorded in the secondary aluminum smelter (2.85; 95% CI: 1.23-5.62), suggesting a significantly elevated risk. In aluminum reduction plants, the SIR was 1.82 (95% CI: 1.59-2.07), while in Söderberg plants, it was 1.69 (95% CI: 1.06-2.57) and 1.4 (95% CI: 1.0-1.9), respectively. For aluminum plants overall, the SIR was 1.30 (95% CI: 1.10-1.50). The results indicate an increased risk, with the highest SMR of 5.90 (95% CI: 1.58-15.1), suggesting a significantly elevated hazard in the secondary aluminum smelter. The other values-3.47 (95% CI: 1.25-9.62) for the aluminum smelter and 2.24 (95% CI: 1.77-2.79) for the aluminum reduction plant-also indicate an increased risk, albeit with varying degrees of statistical certainty.
The International Agency for Research on Cancer has classified aluminum production as a Group 1 carcinogenic activity, providing strong evidence of its association with bladder cancer. The studies primarily included workers from Prebake, Söderberg, and aluminum reduction plants. Some findings indicate a significant yet variable risk across different segments of aluminum production. However, the review did not clearly confirm an increased risk of bladder cancer in specific aluminum-related occupations. Aluminum exposure may influence the lifetime risk of bladder cancer among these workers.
总结1979年至2023年间发表的关于膀胱癌队列研究中铝生产过程职业暴露的关键发现。
本系统评价按照PRISMA指南进行，并在PROSPERO中注册。采用纽卡斯尔-渥太华量表评估研究质量。
文献检索确定了24项队列研究，这些研究考察了铝生产工人中膀胱癌的标准化发病率（SIR）和死亡率比（SMR）。13项研究中的5项考察了SIR（95%CI），16项考察SMR（95%CI）的研究中的3项报告称，铝生产工人患膀胱癌的风险在统计学上显著增加。二次铝冶炼厂的SIR最高（2.85；95%CI：1.23 - 5.62），表明风险显著升高。在铝还原厂，SIR为1.82（95%CI：1.59 - 2.07），而在索德伯格工厂，分别为1.69（95%CI：1.06 - 2.57）和1.4（95%CI：1.0 - 1.9）。总体而言，铝厂的SIR为1.30（95%CI：1.10 - 1.50）。结果表明风险增加，二次铝冶炼厂的最高SMR为5.90（95%CI：1.58 - 15.1），表明危害显著升高。铝冶炼厂的其他值为3.47（95%CI：1.25 - 9.62），铝还原厂为2.24（95%CI：1.77 - 2.79），也表明风险增加，尽管统计确定性程度不同。
国际癌症研究机构已将铝生产归类为第1类致癌活动，有力证明了其与膀胱癌的关联。这些研究主要包括预焙厂、索德伯格厂和铝还原厂的工人。一些发现表明，铝生产的不同环节存在显著但可变的风险。然而，该综述并未明确证实特定铝相关职业中膀胱癌风险增加。铝暴露可能会影响这些工人患膀胱癌的终生风险。
