ارتباط بين مصرف الكل و سرطان پانكراس: يك مرور نظام مند مطالعات هم گروهي

Association between alcohol consumption and pancreatic cancer: a systematic review of cohort studies

در بين انواع سرطان ها، سرطان پانكراس يكي از وخيم ترين پيش آگهي ها را دارد. مصرف اتانول به دليل نقش آن در بسياري از مسيرهاي سيگنالي و متابوليكي سرطان زا و نيز يكي از دلايل اصلي ايجاد پانكراتيت مزمن كه به نوبه خود زمينه ساز ايجاد سرطان پانكراس محسوب مي شود مي تواند از عوامل خطر ابتلا به اين بدخيمي باشد، با اين حال شواهد در اين زمينه متناقض است. اين مطالعه با هدف بررسي جامع مطالعات موجود در زمينه ارتباط بين مصرف مشروبات الكلي و خطر سرطان پانكراس مبتني بر مرور نظام مند مطالعات هم گروهي انجام شد. روش بررسي پايگاه هاي الكترونيكي شامل PubMed،Scopus ، Web of science و Google scholar با استفاده از كلمات كليدي “Pancreatic cancer” و“Alcohol” و كلمات مشابه جستجو شد تا مقالات هم گروهي كه از سال 1990 تا آوريل 2021 در زمينهي الكل و سرطان پانكراس منتشر شده بودند، گردآوري شود. يافته ها در مجموع 858 مقاله شناسايي شد كه از بين آنها 22 مقاله معيارهاي ورود به اين مرور نظام مند را داشتند. نتايج مطالعات به صورت كيفي گزارش شد. بررسي جامع مطالعات نشان داد كه مصرف مقادير كم تا متوسط الكل ارتباط مستقيم غيرمعنا دار با سرطان پانكراس داشت، در حالي كه مصرف مقادير زياد مشروبات الكلي، به ويژه از نوع ليكور ارتباط مستقيم و چشمگيري با خطر سرطان پانكراس يا مرگ ناشي از آن نشان داد. نتيجه گيري مصرف مقادير بالاي الكل در مدت طولاني مي تواند خطر سرطان پانكراس را افزايش دهد. مطالعات تحليلي با مدت پيگيري طولاني تر و كنترل متغيرهاي مخدوشگر جهت دستيابي به نتايج با ثبات و عاري از خطا مورد نياز است.

Among all types of cancers, pancreatic cancer has poor prognosis with 5-year survival below 10%. In theory, alcohol intake may be a modifiable risk factor for pancreatic cancer due to its role in multiple carcinogenic and metabolic signaling pathways. In addition, alcohol consumption may lead to chronic pancreatitis which is underlying cause of pancreatic cancer. However, little is known about whether this factor is associated with pancreatic cancer. This study aimed to systematically review the cohort studies investigating the possible link between alcohol consumption and the morbidity or mortality of pancreatic cancer. Methods This study was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All of cohort studies that assessed the association between alcohol intake and the risk of pancreatic cancer or death were included in this systematic review without a language restriction. Electronic databases including PubMed, Web of science, Scopus, and Google scholar were searched using the keywords "pancreatic cancer" and "alcohol" and similar words from 1990 to April 2021 to find the cohort studies. Results 858 articles were identified, of which 806 were excluded and the full-text of 52 papers were evaluated for the eligibility. Eventually, 22 articles were eligible and were included in this study. Many of the articles assessed the impacts of low to moderate alcohol intake. A comprehensive review of these studies showed that low to moderate alcohol consumption had a non-significant correlation with pancreatic cancer, while high alcohol consumption was significantly associated with the risk of pancreatic cancer or death. The results also revealed that high liquor consumption was associated with higher risk of pancreatic cancer. Nevertheless, the follow-up durations in most of these studies were shorter than that to lead to pancreatic cancer. Conclusion Long-term heavy alcohol drinking can increase the morbidity or mortality of pancreatic cancer. Regarding that several genetic and environmental variations involve in the pathogenesis of this cancer, simultaneous control of these differences should be addressed to determine the net effect of alcohol drinking on pancreatic cancer.