Sarah F Moore, Sarah Price, Judit Konya, Sophie Blummers, Fiona M Walter, Richard D Neal, Gary Abel
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引用次数: 0
Abstract
Background: 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.
Methods: 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.
Findings: 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.
Interpretation: 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.
Funding: This work was supported by a Wellcome doctoral fellowship for primary care clinicians for Sarah Moore (PMHG1A4).
背景：胰腺癌的生存率较低，因为主要是晚期诊断。改善结果的一个策略是早期识别，这可能通过加强监测或改进风险预测模型来实现。这项总括性审查更新了以前的证据，对可能为风险评估提供信息的因素进行了全面评估。方法：在MEDLINE和EMBASE中通过Ovid和Web of Science Core collection自成立以来至2025年3月的Science Citation Index Expanded进行数据库检索。纳入了编码电子医疗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。成分研究的参与者是成年人，我们比较了暴露/未暴露/差异暴露的参与者。没有地域限制。主要结果是胰腺癌的潜在危险因素，按关联程度分类。该研究已在PROSPERO注册，注册号CRD42024526338。结果：2386篇摘要和449篇全文被双重筛选，共纳入168项研究，包括365项针对个体危险因素或分层的荟萃分析，共纳入2,255,495例胰腺癌病例。21项荟萃分析报告了按性别分列的数据，这些数据分别提取并报告。在确定的80个潜在危险因素中，38个与胰腺癌风险增加有关，11个具有保护作用，31个与胰腺癌没有显著关联。新发现的主要危险因素是自身免疫性肝病、BRCA基因突变、乙型和丙型肝炎合并感染和胰岛素使用。解释：本研究对胰腺癌危险因素进行了全面的综述，为确定预防和监测方法、开发风险预测模型和指导未来的研究提供了最新的总结。资助：本研究由Sarah Moore （PMHG1A4）的惠康初级保健临床医生博士奖学金支持。
期刊介绍：
eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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