Reproductive factors are associated with oesophageal cancer risk: results from a meta-analysis of observational studies

Zhu, Yuhui; Yue, Dahai; Yuan, Beibei; Zhu, Liping; Lu, Ming

doi:10.1097/cej.0000000000000234

Cited by 15 publications

(11 citation statements)

References 45 publications

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“…In total, we identified 10,550 records, scrutinized 160 full-text articles, and ultimately included 60 articles (29 systematic reviews of RCTs [ 25 , 26 , 30 , 57 – 82 ], 27 of observational studies [ 27 , 28 , 83 – 107 ], and 4 of both RCTs and observational studies [ 108 – 111 ]) ( Fig 1 ). The studies were published between 1995 and 2017.…”

Section: Resultsmentioning

confidence: 99%

Menopausal hormone therapy and women’s health: An umbrella review

et al. 2021

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Background There remains uncertainty about the impact of menopausal hormone therapy (MHT) on women’s health. A systematic, comprehensive assessment of the effects on multiple outcomes is lacking. We conducted an umbrella review to comprehensively summarize evidence on the benefits and harms of MHT across diverse health outcomes. Methods and findings We searched MEDLINE, EMBASE, and 10 other databases from inception to November 26, 2017, updated on December 17, 2020, to identify systematic reviews or meta-analyses of randomized controlled trials (RCTs) and observational studies investigating effects of MHT, including estrogen-alone therapy (ET) and estrogen plus progestin therapy (EPT), in perimenopausal or postmenopausal women in all countries and settings. All health outcomes in previous systematic reviews were included, including menopausal symptoms, surrogate endpoints, biomarkers, various morbidity outcomes, and mortality. Two investigators independently extracted data and assessed methodological quality of systematic reviews using the updated 16-item AMSTAR 2 instrument. Random-effects robust variance estimation was used to combine effect estimates, and 95% prediction intervals (PIs) were calculated whenever possible. We used the term MHT to encompass ET and EPT, and results are presented for MHT for each outcome, unless otherwise indicated. Sixty systematic reviews were included, involving 102 meta-analyses of RCTs and 38 of observational studies, with 102 unique outcomes. The overall quality of included systematic reviews was moderate to poor. In meta-analyses of RCTs, MHT was beneficial for vasomotor symptoms (frequency: 9 trials, 1,104 women, risk ratio [RR] 0.43, 95% CI 0.33 to 0.57, p < 0.001; severity: 7 trials, 503 women, RR 0.29, 95% CI 0.17 to 0.50, p = 0.002) and all fracture (30 trials, 43,188 women, RR 0.72, 95% CI 0.62 to 0.84, p = 0.002, 95% PI 0.58 to 0.87), as well as vaginal atrophy (intravaginal ET), sexual function, vertebral and nonvertebral fracture, diabetes mellitus, cardiovascular mortality (ET), and colorectal cancer (EPT), but harmful for stroke (17 trials, 37,272 women, RR 1.17, 95% CI 1.05 to 1.29, p = 0.027) and venous thromboembolism (23 trials, 42,292 women, RR 1.60, 95% CI 0.99 to 2.58, p = 0.052, 95% PI 1.03 to 2.99), as well as cardiovascular disease incidence and recurrence, cerebrovascular disease, nonfatal stroke, deep vein thrombosis, gallbladder disease requiring surgery, and lung cancer mortality (EPT). In meta-analyses of observational studies, MHT was associated with decreased risks of cataract, glioma, and esophageal, gastric, and colorectal cancer, but increased risks of pulmonary embolism, cholelithiasis, asthma, meningioma, and thyroid, breast, and ovarian cancer. ET and EPT had opposite effects for endometrial cancer, endometrial hyperplasia, and Alzheimer disease. The major limitations include the inability to address the varying effects of MHT by type, dose, formulation, duration of use, route of administration, and age of initiation and to take into account the quality of individual studies included in the systematic reviews. The study protocol is publicly available on PROSPERO (CRD42017083412). Conclusions MHT has a complex balance of benefits and harms on multiple health outcomes. Some effects differ qualitatively between ET and EPT. The quality of available evidence is only moderate to poor.

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Section: Resultsmentioning

confidence: 99%

Menopausal hormone therapy and women’s health: An umbrella review

et al. 2021

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“…Furthermore, in the development of EAC only breastfeeding has been shown to be associated with a decreased risk of EAC in a study of pooled data from several case–control studies 40 . Two separate meta-analysis 41 , 42 confirmed this finding and suggested that HRT is protective whereas early menopause is a risk factor in the development of esophageal cancer. Further research is needed to provide the answer to the role of androgens and anti-androgens in the etiology of these tumors.…”

Section: Discussionmentioning

confidence: 80%

Risk of esophageal and gastric adenocarcinoma in men receiving androgen deprivation therapy for prostate cancer

Shore

et al. 2021

Sci Rep

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The aim of this study was to explore the male predominance in esophageal and gastric adenocarcinoma by evaluating the preventive potential of androgen deprivation therapy (ADT). This matched cohort study was based on a national Swedish database of prostate cancer patients in 2006–2013. Prostate cancer patients receiving ADT were the exposed group. Prostate cancer-free men from the general population were randomly selected and matched to the index case by birth year and county of residence, forming the unexposed control group. The participants were followed until a diagnosis of esophageal or gastric cancer, death, emigration, or end of the study period. The risk of esophageal adenocarcinoma, cardia gastric adenocarcinoma, non-cardia gastric adenocarcinoma, and esophageal squamous-cell carcinoma among ADT-exposed compared to unexposed was calculated by multivariable Cox proportional hazard regression. The hazard ratios (HRs) and 95% confidence intervals (CIs) were adjusted for confounders. There was a risk reduction of non-cardia gastric adenocarcinoma among ADT-users compared to non-users (HR 0.49 [95% CI 0.24–0.98]). No such decreased risk was found for esophageal adenocarcinoma (HR 1.17 [95% CI 0.60–2.32]), cardia gastric adenocarcinoma (HR 0.99 [95% CI 0.40–2.46]), or esophageal squamous cell carcinoma (HR 0.99 [95% CI 0.31–3.13]). This study indicates that androgen deprivation therapy decreases the risk of non-cardia gastric adenocarcinoma, while no decreased risk was found for esophageal adenocarcinoma, cardia gastric adenocarcinoma, or esophageal squamous-cell carcinoma.

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“…But some limitations should be mentioned in interpreting our findings. Firstly, studies 30,31 have shown that postmenopausal women have a higher risk of esophageal cancer than premenopausal and perimenopausal women. So, age-specific incidence and mortality in postmenopausal women should be taken into consideration in our study.…”

Section: Discussionmentioning

confidence: 99%

Trends of Esophageal Cancer Incidence and Mortality and Its Influencing Factors in China

Li¹,

Liu²,

Jiao³

et al. 2021

RMHP

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To explore the esophageal cancer (EC) incidence and mortality trends and risk factors in China during [2005][2006][2007][2008][2009][2010][2011][2012][2013][2014][2015]. Materials and Methods: The data were stratified by area (urban, rural), gender (male, female), and age groups (0 ~, 5 ~, …, 85 ~). The age-standardized incidence rate (ASIR) and mortality rate (ASMR), age-specific incidence and mortality were calculated to describe the trends, which were analyzed by Joinpoint software, negative binomial regression model, and age-period-cohort model. Results: Trends in EC ASIR decreased markedly during 2010-2015 (APC=−6.14%, P<0.05), and the average annual percent change (AAPC) value was −8.07% (95% confidence interval (CI): −9.98~−6.12) for rural areas during 2005-2015. The ASMR was on a fastdownward trend after 2011 (APC=−6.67%, P<0.05), with AAPC values of −1.34% (95% CI: −2.56~−0.19) for males, −3.39% (95% CI: −5.65, −1.07) for females, and −9.67% (95% CI: −10.56~−8.77) for rural areas during 2005-2015. The age-specific incidence and mortality increased with age. The risk of EC for males was 3.1675 times higher than females (P<0.001), and for urban areas, it was 0.58 times larger than rural (P<0.001). The age and period effects presented an increasing trend, with a decreasing trend for the cohort effects in incidence and mortality risk. Later birth cohorts presented lower risks than previous birth cohorts. Conclusion: ASIR and ASMR in China are higher in males than females, and higher in rural than urban areas, which have decreased during 2005-2015, especially in rural areas. The incidence increased with age up to the peak age group of 75. Area, gender, and age were independent risk factors for EC incidence.

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Reproductive factors are associated with oesophageal cancer risk: results from a meta-analysis of observational studies

Cited by 15 publications

References 45 publications

Menopausal hormone therapy and women’s health: An umbrella review

Menopausal hormone therapy and women’s health: An umbrella review

Risk of esophageal and gastric adenocarcinoma in men receiving androgen deprivation therapy for prostate cancer

Trends of Esophageal Cancer Incidence and Mortality and Its Influencing Factors in China

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