Moore Sarah F, Price Sarah, Konya Judit, Blummers Sophie, Walter Fiona M, Neal Richard D, Abel Gary
Faculty of Health and Life Sciences, University of Exeter, UK.
Wolfson Institute for Population Health, QMUL, UK.
EClinicalMedicine. 2025 Jun 14;85:103297. doi: 10.1016/j.eclinm.2025.103297. eCollection 2025 Jul.
Pancreatic cancer has poor survival because of predominantly advanced-stage diagnosis. One strategy for improving outcomes is earlier identification, possibly achievable by enhanced surveillance or improved risk prediction modelling. This umbrella review updates previous evidence with a comprehensive assessment of factors which could inform risk assessments.
Database searches were performed in MEDLINE and EMBASE via Ovid and the Science Citation Index Expanded of the Web of Science Core collection from inception to March 2025. Systematic reviews and meta-analyses of factors associated with altered risk of pancreatic cancer, available in a coded electronic healthcare record, were included. Participants in component studies were adults, and we compared exposed/not exposed/differentially exposed participants. There was no geographical restriction. The main outcome was potential risk factors for pancreatic cancer, categorised by degree of association. The study was registered with PROSPERO, registration number CRD42024526338.
2386 abstracts and 449 full texts were dual screened, resulting in 168 studies included in the review, comprising 365 meta-analyses of individual risk factors or strata and >2,255,495 pancreatic cancer cases. 21 meta-analyses reported gender-disaggregated data which were extracted and reported separately.Of the 80 potential risk factors identified, 38 were associated with an increased pancreatic cancer risk, 11 with a protective effect, and 31 had no significant association with pancreatic cancer. Major newly found risk factors were autoimmune liver disease, BRCA gene mutation, co-infection with hepatitis B and C, and insulin use.
This comprehensive umbrella review of pancreatic cancer risk factors provides an up-to-date summary useful for identifying prevention and surveillance approaches, and for developing risk prediction models and directing future research.
This work was supported by a Wellcome doctoral fellowship for primary care clinicians for Sarah Moore (PMHG1A4).
胰腺癌的生存率较低，主要原因是诊断时多处于晚期。改善预后的一种策略是早期识别，这可能通过加强监测或改进风险预测模型来实现。本系统评价通过全面评估可能为风险评估提供依据的因素，更新了先前的证据。
通过Ovid在MEDLINE和EMBASE数据库以及Web of Science核心合集的科学引文索引扩展版中进行数据库检索，检索时间从建库至2025年3月。纳入对编码电子健康记录中与胰腺癌风险改变相关因素的系统评价和荟萃分析。纳入研究的参与者为成年人，我们比较了暴露/未暴露/差异暴露的参与者。无地理限制。主要结局是胰腺癌的潜在风险因素，按关联程度分类。该研究已在PROSPERO注册，注册号为CRD42024526338。
对2386篇摘要和449篇全文进行了双人筛选，最终纳入168项研究进行综述，包括365项个体风险因素或分层的荟萃分析以及超过2255495例胰腺癌病例。21项荟萃分析报告了按性别分类的数据，并单独提取和报告。在确定的80个潜在风险因素中，38个与胰腺癌风险增加相关，11个具有保护作用，31个与胰腺癌无显著关联。新发现的主要风险因素包括自身免疫性肝病、BRCA基因突变、乙肝和丙肝合并感染以及胰岛素使用。
这项对胰腺癌风险因素的全面系统评价提供了最新的总结，有助于确定预防和监测方法、开发风险预测模型以及指导未来研究。
这项工作得到了惠康基金会为初级保健临床医生提供的博士奖学金（PMHG1A4），资助对象为莎拉·摩尔。
