Environmental risk factors for gallbladder cancer: field-wide systematic review and meta-analysis.

environmental exposure epidemiology gallbladder neoplasms prevention and control risk factors

Journal

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
ISSN: 1542-7714
Titre abrégé: Clin Gastroenterol Hepatol
Pays: United States
ID NLM: 101160775

Informations de publication

Date de publication:
04 Oct 2024
Historique:
received: 04 06 2024
revised: 26 07 2024
accepted: 28 07 2024
medline: 7 10 2024
pubmed: 7 10 2024
entrez: 6 10 2024
Statut: aheadofprint

Résumé

Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC. We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and non-randomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval, P-value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding. We identified 215 eligible primary studies and performed 350 meta-analyses across seven domains: lifestyle; reproductive; metabolic; dietary; infections; interventions; contaminants, and occupational exposures. Based on longitudinal evidence, body-mass index (RR per 5-unit increase 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase 1.16; 1.11‒1.22), infection of bile ducts (RR 31.7; 24.8-40.6), high parity (RR 1.48, 1.30‒1.68), obesity (RR 1.70; 1.44‒2.01), overweight (RR 1.28; 1.14‒1.43), waist circumference (RR per 5-cm increase 1.14; 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase 1.49; 1.36‒1.64) were robustly associated with increased GBC risk, while high education (RR 0.63; 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption and insufficient physical activity. This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas.

Sections du résumé

BACKGROUND AND AIMS OBJECTIVE
Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.
METHODS METHODS
We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and non-randomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval, P-value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.
RESULTS RESULTS
We identified 215 eligible primary studies and performed 350 meta-analyses across seven domains: lifestyle; reproductive; metabolic; dietary; infections; interventions; contaminants, and occupational exposures. Based on longitudinal evidence, body-mass index (RR per 5-unit increase 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase 1.16; 1.11‒1.22), infection of bile ducts (RR 31.7; 24.8-40.6), high parity (RR 1.48, 1.30‒1.68), obesity (RR 1.70; 1.44‒2.01), overweight (RR 1.28; 1.14‒1.43), waist circumference (RR per 5-cm increase 1.14; 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase 1.49; 1.36‒1.64) were robustly associated with increased GBC risk, while high education (RR 0.63; 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption and insufficient physical activity.
CONCLUSIONS CONCLUSIONS
This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas.

Identifiants

DOI: 10.1016/j.cgh.2024.07.046 PMID: 39370088
pubmed: 39370088
pii: S1542-3565(24)00866-8
doi: 10.1016/j.cgh.2024.07.046
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Daniele Piovani (D)

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. Electronic address: daniele.piovani@hunimed.it.

Georgios K Nikolopoulos (GK)

Laboratory of Medical Statistics, Epidemiology and Public Health, Medical School, University of Cyprus, Nicosia, Cyprus. Electronic address: nikolopoulos.georgios@ucy.ac.cy.

Alessio Aghemo (A)

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. Electronic address: alessio.aghemo@hunimed.eu.

Ana Lleo (A)

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. Electronic address: ana.lleo@hunimed.eu.

Saleh A Alqahtani (SA)

Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD, USA. Electronic address: salqaht1@jhmi.edu.

Cesare Hassan (C)

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. Electronic address: cesare.hassan@hunimed.eu.

Alessandro Repici (A)

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. Electronic address: alessandro.repici@hunimed.eu.

Stefanos Bonovas (S)

Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. Electronic address: stefanos.bonovas@hunimed.eu.

Classifications MeSH