Feng Minghao, Wang Feng, Bao Minwei, Zhu Lei
Department of Thoracic Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Radiotherapy, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Front Public Health. 2025 Jul 22;13:1623840. doi: 10.3389/fpubh.2025.1623840. eCollection 2025.
Lung cancer remains a leading cause of cancer-related mortality worldwide, with environmental exposures and lifestyle factors playing a crucial role in its etiology. This umbrella review aims to systematically assess and classify the strength of evidence for environmental and lifestyle factors associated with lung cancer risk.
A systematic search of published meta-analyses was conducted from database inception until January 31, 2025. Eligible meta-analyses included those evaluating associations between environmental or lifestyle exposures and lung cancer risk, with effect sizes reported as risk ratio (RR), odds ratios (OR), or standardized mortality ratios (SMR). The credibility of associations was assessed using statistical significance, heterogeneity ( ), small-study effects, and excess significance bias. The evidence was categorized into convincing (Class I), highly suggestive (Class II), suggestive (Class III), and weak or non-significant associations.
A total of 58 meta-analyses covering 34 environmental factors and 24 lifestyle factors were included. Three environmental exposures-cadmium exposure (RR = 1.24, 95% CI: 1.18-1.29), diesel exhaust exposure (RR = 1.16, 95% CI: 1.13-1.18), and occupational exposure to paints (OR = 1.40, 95% CI: 1.29-1.51)-were classified as convincing evidence (Class I). Fifteen additional environmental factors, including secondhand smoke, benzene, formaldehyde, and indoor coal use, were classified as highly suggestive evidence (Class II). Among lifestyle factors, cooking-related exposures (OR = 1.21, 95% CI: 1.10-1.31) showed a convincing association with lung cancer risk, while dietary cholesterol intake (OR = 1.40, 95% CI: 1.20-1.64) and the Western dietary pattern (RR = 1.29, 95% CI: 1.01-1.66) were classified as highly suggestive evidence. Dietary patterns associated with reduced lung cancer risk included the Mediterranean diet (RR = 0.87, 95% CI: 0.82-0.93) and the prudent dietary pattern (RR = 0.80, 95% CI: 0.64-0.96), both of which were significantly associated with lower lung cancer risk. Heterogeneity was substantial in 48.57% of environmental associations and 39.13% of lifestyle associations, highlighting potential confounding factors.
This umbrella review highlights multiple environmental and lifestyle exposures with strong or suggestive associations with lung cancer. These findings support stricter environmental regulations, workplace protections, and lifestyle interventions. Future research should prioritize biomarker-based exposure assessments and long-term cohort studies to refine risk estimates and inform prevention strategies.
The study is registered with PROSPERO, number 1003974.
肺癌仍是全球癌症相关死亡的主要原因，环境暴露和生活方式因素在其病因中起着关键作用。本伞状综述旨在系统评估和分类与肺癌风险相关的环境和生活方式因素的证据强度。
从数据库建立至2025年1月31日对已发表的荟萃分析进行系统检索。符合条件的荟萃分析包括那些评估环境或生活方式暴露与肺癌风险之间的关联，效应量报告为风险比（RR）、比值比（OR）或标准化死亡比（SMR）。使用统计学显著性、异质性（ ）、小研究效应和过度显著性偏差评估关联的可信度。证据分为令人信服（I类）、高度提示性（II类）、提示性（III类）以及弱关联或无显著关联。
共纳入58项涵盖34个环境因素和24个生活方式因素的荟萃分析。三种环境暴露——镉暴露（RR = 1.24，95% CI：1.18 - 1.29）、柴油废气暴露（RR = 1.16，95% CI：1.13 - 1.18）和职业接触油漆（OR = 1.40，95% CI：1.29 - 1.51）——被归类为令人信服的证据（I类）。另外15个环境因素，包括二手烟、苯、甲醛和室内燃煤，被归类为高度提示性证据（II类）。在生活方式因素中，与烹饪相关的暴露（OR = 1.21，95% CI：1.10 - 1.31）与肺癌风险存在令人信服的关联，而膳食胆固醇摄入量（OR = 1.40，95% CI：1.20 - 1.64）和西方饮食模式（RR = 1.29，95% CI：1.01 - 1.66）被归类为高度提示性证据。与降低肺癌风险相关的饮食模式包括地中海饮食（RR = 0.87，95% CI：0.82 - 0.93）和谨慎饮食模式（RR = 0.80，95% CI：0.64 - 0.96），两者均与较低的肺癌风险显著相关。48.57%的环境关联和39.13%的生活方式关联存在显著异质性，突出了潜在的混杂因素。
本伞状综述强调了多种与肺癌有强关联或提示性关联的环境和生活方式暴露。这些发现支持更严格的环境法规、工作场所保护和生活方式干预。未来的研究应优先基于生物标志物的暴露评估和长期队列研究，以完善风险估计并为预防策略提供信息。
该研究已在PROSPERO注册，注册号为1003974。
