结肠癌危险因素的Meta分析
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摘要
目的运用系统评价方式探讨结肠癌危险因素,为更好地预防结肠癌提供循证依据。方法计算机检索中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普系列数据库、The Cochrane Library、PubMed、SpringerLink、EBSCO、MEDLINE等数据库,检索文献发表时间为2000年1月1日至2018年10月31日,检索词包括"结肠癌"、"结肠肿瘤"、"结肠组织癌性病变"、"危险因素"及其自由词的病例对照试验相关文献。在尽可能全面地收集相关病例对照试验数据资料的基础上,根据纳入和排除标准,并采用Newcastle-Ottawa Scale(NOS)文献质量评价表的评价标准对所提取文献进行质量评价,将得分≥7分(高质量)的文献纳入研究,最后采用RevMan5.3对其进行Meta分析。结果 13篇文献符合纳入标准,累计病例数和对照数分别为该2 773例和8 117例,经Meta分析结果显示,结肠癌的危险因素为:结肠癌家族史(OR=2.13,95%CI:1.58～2.87)、精神心理问题(OR=1.50,95%CI:1.09～2.05)、低膳食纤维饮食(OR=1.17,95%CI:0.94～1.46)、高脂高蛋白饮食(OR=1.35,95%CI:1.11～1.64)、缺乏运动(OR=1.16,95%CI:0.97～1.38)、消化系统疾病(OR=1.82,95%CI:1.31～2.53)及饮酒(OR=1.38,95%CI:1.11～1.71)。结论结肠癌家族史、精神心理问题、低食纤维饮食、高脂高蛋白饮食、缺乏运动、消化系统疾病及饮酒是结肠癌的独立危险因素,控制上述因素可以有效降低结肠癌患者的死亡风险。
Objective To explore the risk factors of colon cancer by means of systematic evaluation, and provide evidence for the prevention of colon cancer. Methods The literatures published from January 1 st 2000 to October 31 st 2018 were searched in CNKI, CBM, Wanfang Database, VIP Series Database, The Cochrane Library, PubMed Database, Springer Link Full-text Database, EBSCO Full-text Database, Quanfang Medline Document Service and other databases. "colon cancer", "colon tumor", "cancerous lesion of colon tissue", "risk factors" and their free words were selected as keywords. The literatures were evaluated and filtrated by Newcastle-Ottawa Scale. The Meta-analysis were performed in the literatures scored above 7. Results A total of 13 articles were included in the Meta-analysis with the cumulative number of cases and controls reaching 2 773 and 8 117 respectively. Meta-analysis showed that the risk factors for colon cancer were family history of colon cancer(OR=2.13, 95%CI:1.58-2.87), psychological problems(OR=1.50, 95 %CI: 1.09-2.05), low dietary fiber diet(OR=1.17, 95 % CI: 0.94-1.46), high fat and high protein diet(OR=1.35, 95 % CI: 1.11-1.11), lack of exercise(OR=1.16,95%CI:0.97-1.38), digestive system disease(OR=1.82,95%CI:1.31-2.53) and alcohol consumption(OR=1.38,95%CI:1.11-1.71). Conclusions Family history of colon cancer, mental and psychological problems, low dietary fiber, high-fat and high-protein diet, lack of exercise, digestive system diseases and alcohol consumption are independent risk factors for colon cancer. The mortality risk for colon cancer patients can be reduced effectively by controlling these factors.
Objective To explore the risk factors of colon cancer by means of systematic evaluation, and provide evidence for the prevention of colon cancer. Methods The literatures published from January 1 st 2000 to October 31 st 2018 were searched in CNKI, CBM, Wanfang Database, VIP Series Database, The Cochrane Library, PubMed Database, Springer Link Full-text Database, EBSCO Full-text Database, Quanfang Medline Document Service and other databases. "colon cancer", "colon tumor", "cancerous lesion of colon tissue", "risk factors" and their free words were selected as keywords. The literatures were evaluated and filtrated by Newcastle-Ottawa Scale. The Meta-analysis were performed in the literatures scored above 7. Results A total of 13 articles were included in the Meta-analysis with the cumulative number of cases and controls reaching 2 773 and 8 117 respectively. Meta-analysis showed that the risk factors for colon cancer were family history of colon cancer(OR=2.13, 95%CI:1.58-2.87), psychological problems(OR=1.50, 95 %CI: 1.09-2.05), low dietary fiber diet(OR=1.17, 95 % CI: 0.94-1.46), high fat and high protein diet(OR=1.35, 95 % CI: 1.11-1.11), lack of exercise(OR=1.16,95%CI:0.97-1.38), digestive system disease(OR=1.82,95%CI:1.31-2.53) and alcohol consumption(OR=1.38,95%CI:1.11-1.71). Conclusions Family history of colon cancer, mental and psychological problems, low dietary fiber, high-fat and high-protein diet, lack of exercise, digestive system diseases and alcohol consumption are independent risk factors for colon cancer. The mortality risk for colon cancer patients can be reduced effectively by controlling these factors.
引文
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[14] 赵俊仕,Min-zhu H,吴心音,等.结肠癌危险因素的病例对照研究[J].肿瘤防治研究,2008,35(7):524-526.
[15] 陈俊,朱红岗,夏丽琴.结肠癌饮食危险因素病例对照研究[J].中国公共卫生,2010,26(4):441.
[16] Fernandez E,Gallus S,La Vecchia C,et al.Family history and environmental risk factors for colon cancer[J].Cancer Epidemiol Biomarkers Prev,2004,13(4):658-661.
[17] Kaerlev L,Lynge E,Sabroe S,et al.Colon cancer controls versus population controls in case-control studies of occupational risk factors[J].BMC Cancer,2004,4:15.
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[19] 王嘉淇,关宝生,杜宁,等.动物性食品和植物性食品在大肠癌危险因素中的作用Meta分析[J].黑龙江医药科学,2008,31(4):53-54.
[20] 沙怡梅.094 膳食因素致结肠癌的可能机制[J].国外医学(卫生学分册),2002,29(4):241-246.
[21] Ben Q,Sun Y,Chai R,et al.Dietary fiber intake reduces risk for colorectal adenoma:a meta-analysis[J].Gastroenterology,2014,146(3):689-699.
[22] Thune I,Lund E.Physical activity and risk of colorectal cancer in men and women[J].Br J Cancer,1996,73(9):1134-1140.
[23] 陈坤,裘炯良,张扬.大肠癌危险因素的Meta分析[J].浙江大学学报(医学版),2002,31(4):254-258.
[24] 张宗卫.心理因素与癌症[J].中国肿瘤,2006,15(11):711-713.
[25] Chida Y,Hamer M,Wardle J,et al.Do stress-related psychosocial factors contribute to cancer incidence and survival [J].Nat Clin Pract Oncol,2008,5(8):466-475.
[26] Cai S,Li Y,Ding Y,et al.Alcohol drinking and the risk of colorectal cancer death:a meta-analysis[J].Eur J Cancer Prev,2014,23(6):532-539.
[27] Yang G,Zheng W,Xiang YB,et al.Green tea consumption and colorectal cancer risk:a report from the Shanghai Men's Health Study[J].Carcinogenesis,2011,32(11):1684-1688.
[28] Kim HJ,Lee SM,Choi NK,et al.Smoking and colorectal cancer risk in the Korean elderly [J].J Prev Med Public Health,2006,39(2):123-129.
[2] 段纪俊,严亚琼,杨念念,等.中国恶性肿瘤发病与死亡的国际比较分析[J].中国医学前沿杂志(电子版),2016,8(7):17-23.
[3] Kim JW,Park JW,Park SC,et al.Clinical outcomes of laparoscopic versus open surgery for primary tumor resection in patients with stage IV colorectal cancer with unresectable metastasis[J].Surg Today,2015,45(6):752-758.
[4] Greenland S.Quantitative methods in the review of epidemiologic literature[J].Epidemiol Rev,1987,9:1-30.
[5] 孙小莉,曹晓侠,丁晓明,等.宝鸡地区80例结肠癌患者发病危险因素研究[J].现代生物医学进展,2016,16(23):4505-4507,4519.
[6] 李玲,王启俊,祝伟星,等.北京市结肠癌危险因素的病例对照研究[J].中国肿瘤临床,2003,30(8):556-558.
[7] 汪祥辉,雷通海,吕桂泉,等.大肠癌高发区居民结肠癌危险因素研究[J].中华肿瘤杂志,2001,23(6):480-482.
[8] 陈功,万德森,潘志忠,等.广州市结肠癌危险因素的病例对照研究[J].癌症,2001,20(10):1086-1088.
[9] 曲歌,徐帅,侯明星,等.呼和浩特市结肠癌病例饮食危险因素的对照研究[J].内蒙古医科大学学报,2016,38(4):354-356.
[10] 王阿静.基于病例对照研究的结肠癌危险因素分析[J].国外医学(医学地理分册),2016,37(3):247-251.
[11] 汪祥辉,雷通海,马新源,等.结肠癌危险因素的病例对照研究[J].癌症,2001,20(9):977-980.
[12] 宗振久,张红军,王曦,等.结肠癌发病的危险因素logistic回归分析[J].中国医药指南,2012,10(12):160-161.
[13] 陈坤,蔡剑,刘希永,等.结肠癌和直肠癌危险因素的巢式病例对照研究[J].中华流行病学杂志,2001,22(6):739-441.
[14] 赵俊仕,Min-zhu H,吴心音,等.结肠癌危险因素的病例对照研究[J].肿瘤防治研究,2008,35(7):524-526.
[15] 陈俊,朱红岗,夏丽琴.结肠癌饮食危险因素病例对照研究[J].中国公共卫生,2010,26(4):441.
[16] Fernandez E,Gallus S,La Vecchia C,et al.Family history and environmental risk factors for colon cancer[J].Cancer Epidemiol Biomarkers Prev,2004,13(4):658-661.
[17] Kaerlev L,Lynge E,Sabroe S,et al.Colon cancer controls versus population controls in case-control studies of occupational risk factors[J].BMC Cancer,2004,4:15.
[18] Yiu HY,Whittemore AS,Shibata A.Increasing colorectal cancer incidence rates in Japan[J].Int J Cancer,2004,109(5):777-781.
[19] 王嘉淇,关宝生,杜宁,等.动物性食品和植物性食品在大肠癌危险因素中的作用Meta分析[J].黑龙江医药科学,2008,31(4):53-54.
[20] 沙怡梅.094 膳食因素致结肠癌的可能机制[J].国外医学(卫生学分册),2002,29(4):241-246.
[21] Ben Q,Sun Y,Chai R,et al.Dietary fiber intake reduces risk for colorectal adenoma:a meta-analysis[J].Gastroenterology,2014,146(3):689-699.
[22] Thune I,Lund E.Physical activity and risk of colorectal cancer in men and women[J].Br J Cancer,1996,73(9):1134-1140.
[23] 陈坤,裘炯良,张扬.大肠癌危险因素的Meta分析[J].浙江大学学报(医学版),2002,31(4):254-258.
[24] 张宗卫.心理因素与癌症[J].中国肿瘤,2006,15(11):711-713.
[25] Chida Y,Hamer M,Wardle J,et al.Do stress-related psychosocial factors contribute to cancer incidence and survival [J].Nat Clin Pract Oncol,2008,5(8):466-475.
[26] Cai S,Li Y,Ding Y,et al.Alcohol drinking and the risk of colorectal cancer death:a meta-analysis[J].Eur J Cancer Prev,2014,23(6):532-539.
[27] Yang G,Zheng W,Xiang YB,et al.Green tea consumption and colorectal cancer risk:a report from the Shanghai Men's Health Study[J].Carcinogenesis,2011,32(11):1684-1688.
[28] Kim HJ,Lee SM,Choi NK,et al.Smoking and colorectal cancer risk in the Korean elderly [J].J Prev Med Public Health,2006,39(2):123-129.