Cancer Res Treat.  2021 Jan;53(1):223-232. 10.4143/crt.2020.546.

Adherence to Cancer Prevention Guidelines and Endometrial Cancer Risk: Evidence from a Systematic Review and Dose-Response Meta-analysis of Prospective Studies

• Sun H
• Chang Q
• Liu YS
• Jiang YT
• Gong TT
• Ma XX
• Zhao YH
• Wu QJ

• KMID: 2510664
• DOI: http://doi.org/10.4143/crt.2020.546

Abstract

Purpose
The evidence of adherence to cancer prevention guidelines and endometrial cancer (EC) risk has been limited and controversial. This study summarizes and quantifies the relationship between adherence to cancer prevention guidelines and EC risk.
Materials and Methods
The online databases PubMed, Web of Science, and EMBASE were searched for relevant publications up to June 2, 2020. This study had been registered at PROSPERO. The registration number is CRD42020149966. Study quality evaluation was performed based on the Newcastle-Ottawa Scale. The I² statistic was used to estimate heterogeneity among studies. Egger’s and Begg’s tests assessed potential publication bias. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) for the relationship between adherence to cancer prevention guidelines score was assigned to participants by summarizing individual scores for each lifestyle-related factor. The scores ranged from least healthy (0) to most healthy (20) and the EC risk was calculated using a randomeffects model.
Results
Five prospective studies (four cohort studies and one case‑cohort study) consisted of 4,470 EC cases, where 597,047 participants were included. Four studies had a low bias risk and one study had a high bias risk. Summary EC HR for the highest vs. lowest score of adherence to cancer prevention guidelines was 0.54 (95% CI, 0.40 to 0.73) and had a high heterogeneity (I²=86.1%). For the dose-response analysis, an increment of 1 significantly reduced the risk of EC by 6%. No significant publication bias was detected.
Conclusion
This study suggested that adherence to cancer prevention guidelines was negatively related to EC risk.

Keyword

Cancer prevention guidelines; Endometrial neoplasms; Risk; Prospective study; Systematic review

Figure

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  Fig. 1 Flowchart for the selection of the original studies on the association between adherence to cancer prevention guidelines score and the endometrial cancer risk included in the meta-analysis.

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  Fig. 2 Forest plot for the association between adherence to cancer prevention guidelines score and the endometrial cancer risk using a random-effects model [12–14,16,17]. The squares indicate study-specific hazard ratio (size of the square reflects the study-specific statistical weight); the horizontal lines indicate 95% confidence intervals (CIs); and the diamond indicates the summary hazard ratio (HR) estimate with its 95% CI.

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  Fig. 3 Funnel plot with pseudo 95% confidence limits for the analysis of adherence to cancer prevention guidelines score and the endometrial cancer risk. HR, hazard ratio.

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  Fig. 4 Sensitivity analysis was performed by removing each study in turn and recalculating the summary hazard ratios estimate [12–14,16,17].

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  Fig. 5 Forest plot for the association between adherence to cancer prevention guidelines score and the endometrial cancer risk using a random-effects model in sensitivity analysis [13–17]. The squares indicate study-specific hazard ratio (size of the square reflects the study-specific statistical weight); the horizontal lines indicate 95% confidence intervals (CIs); and the diamond indicates the summary hazard ratio (HR) estimate with its 95% CI.

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  Fig. 6 Forest plot for the dose-response meta-analysis of the relationship between adherence to cancer prevention guidelines scores and the endometrial cancer risk using a random-effects model [12,13,17]. The squares indicate study-specific hazard ratio (HR) (size of the square reflects the study-specific statistical weight); the horizontal lines indicate 95% confidence intervals (CIs); and the diamond indicates the summary HR estimate with its 95% CI.

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