咖啡，包括咖啡因和脱咖啡因咖啡以及肝细胞癌的风险：系

StephenW

BMJ Open. 2017 May 9;7(5):e013739. doi: 10.1136/bmjopen-2016-013739.
Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose-response meta-analysis.
Kennedy OJ1, Roderick P1, Buchanan R1, Fallowfield JA2, Hayes PC2, Parkes J1.
Author information

1    Primary Care and Population Sciences Faculty of Medicine, University of Southampton, Southampton, UK.
2    MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.

Abstract
OBJECTIVES:

To examine the association between coffee, including caffeinated and decaffeinated coffee, with hepatocellular carcinoma (HCC) and assess the influence of HCC aetiology and pre-existing liver disease.
DESIGN:

We performed a systematic review and meta-analysis. We calculated relative risks (RRs) of HCC according to caffeinated and decaffeinated coffee consumption using a random-effects dose-response meta-analysis. We tested for modification of the effect estimate by HCC aetiology and pre-existing liver disease. We judged the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.
RESULTS:

We found 18 cohorts, involving 2 272 642 participants and 2905 cases, and 8 case-control studies, involving 1825 cases and 4652 controls. An extra two cups per day of coffee was associated with a 35% reduction in the risk of HCC (RR 0.65, 95% CI 0.59 to 0.72). The inverse association was weaker for cohorts (RR 0.71, 95% CI 0.65 to 0.77), which were generally of higher quality than case-control studies (RR 0.53, 95% CI 0.41 to 0.69). There was evidence that the association was not significantly altered by stage of liver disease or the presence/absence of high alcohol consumption, high body mass index, type 2 diabetes mellitus, smoking, or hepatitis B and C viruses. An extra two cups of caffeinated and decaffeinated coffee (2 and 3 cohort studies, respectively) were associated with reductions of 27% (RR 0.73, 95% CI 0.63 to 0.85) and 14% (RR 0.86, 95% CI 0.74 to 1.00) in the risk of HCC. However, due to a lack of randomised controlled trials, potential publication bias and there being no accepted definition of coffee, the quality of evidence under the GRADE criteria was 'very low'.
CONCLUSIONS:

Increased consumption of caffeinated coffee and, to a lesser extent, decaffeinated coffee are associated with reduced risk of HCC, including in pre-existing liver disease. These findings are important given the increasing incidence of HCC globally and its poor prognosis.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
KEYWORDS:

HCC; coffee; hepatocellular carcinoma; liver disease; meta-analysis

PMID:
    28490552
DOI:
    10.1136/bmjopen-2016-013739

StephenW

BMJ开放。 2017年5月9日; 7（5）：e013739。 doi：10.1136 / bmjopen-2016-013739。
咖啡，包括咖啡因和脱咖啡因咖啡以及肝细胞癌的风险：系统评价和剂量反应荟萃分析。
Kennedy OJ1，Roderick P1，Buchanan R1，Fallowfield JA2，Hayes PC2，Parkes J1。
作者信息

1初级保健和人口科学南安普敦大学医学院，南安普敦，英国。
2英国爱丁堡爱丁堡大学MRC中心炎症研究中心。

抽象
目的：

检查咖啡，包括咖啡因和脱咖啡因咖啡与肝细胞癌（HCC）之间的关联，并评估肝癌病因和预先存在的肝脏疾病的影响。
设计：

我们进行了系统评价和荟萃分析。我们使用随机效应剂量反应荟萃分析，根据含咖啡因和去咖啡因的咖啡消耗计算HCC的相对风险（RR）。我们测试了HCC病因和预先存在的肝脏疾病对效应估计的修改。我们使用评估，开发和评估（GRADE）评估标准来评估证据的质量。
结果：

共查获18人，其中涉及2 272 642人次，2905例，8例病例对照研究，共1825例，4652例。每天额外的两杯咖啡与HCC的风险降低了35％（RR 0.65,95％CI为0.59至0.72）。反向关联对于队列（RR 0.71,95％CI 0.65至0.77）较弱，通常比病例对照研究更高质量（RR 0.53,95％CI 0.41至0.69）。有证据表明，肝脏疾病阶段或高酒精消耗量，高体重指数，2型糖尿病，吸烟或乙型和丙型肝炎病毒的存在/不存在，协会没有显着改变。额外的两杯咖啡因和脱咖啡因咖啡（分别为2和3组队列研究）与减少27％（RR 0.73,95％CI 0.63至0.85）和14％（RR 0.86,95％CI 0.74至1.00）有关，在HCC的风险。然而，由于缺乏随机对照试验，潜在的出版偏倚和咖啡没有接受的定义，GRADE标准下的证据质量“非常低”。
结论：

咖啡因咖啡的消费量增加，以及较少程度上脱咖啡因的咖啡的消耗与HCC的风险降低有关，包括预先存在的肝脏疾病。这些发现是重要的，因为全球HCC发病率增加及其预后不良。

©文章作者（或其雇主，除非在文章的文本中另有说明）2017.保留所有权利。除非另有明确授予，否则不允许商业使用。
关键词：

HCC;咖啡;肝细胞癌;肝病;荟萃分析

结论：
    28490552
DOI：
    10.1136 / bmjopen-2016-013739

StephenW

http://bmjopen.bmj.com/content/7/5/e013739.long