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Publications

Journal Article Systematic Review Epublish

PubMed: 40641920 DOI: 10.3389/fonc.2025.1564575

Risk factors for gastric cancer: an umbrella review of systematic reviews and meta-analyses.

Front Oncol 15:1564575

Authors: Jin Long Liang, Hui Ming Yuan, Chao Quan, Jun Qiang Chen

Affiliations

  • Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, Nanning, China. Guangxi key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, Nanning, China. Guangxi Clinical Research Center for Enhanced Recovery after Surgery, Nanning, China. Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumor Images, Nanning, China.
  • Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, United States. Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Abstract

Background

This umbrella review aims to critically appraise and synthesize epidemiological evidence from meta-analyses to identify and classify risk and protective factors associated with gastric cancer.

Methods

PubMed, Embase, Web of Science, and the Cochrane were used to search, including meta-analyses up to April 2024. Emphasis was placed on non-interventional studies, and the inclusion criteria focused on meta-analyses that involved diverse ethnic groups and genders from various countries and settings. Two reviewers independently evaluated the methodological quality using the AMSTAR tool and classified evidence strength based on established criteria.

Results

Of 245 meta-analyses meeting inclusion criteria, 117 unique risk factors were identified, including 77 significantly associated factors (42 adverse and 35 protective) and 40 non-significant factors. 17 (14.5%) risk factors were classified as class I or II evidence in this umbrella review. Protective factors included cruciferous vegetable intake, total cholesterol (TC), HDL cholesterol (HDL-C), NSAIDs, β-carotene, vitamins, and dietary polyphenols. Risk factors included depression, Helicobacter pylori (Hp) infection, dermatomyositis, and Graves' disease. Class III evidence confirmed that aspirin, non-aspirin NSAIDs, soy food intake, non-fermented soy food intake, physical activity, vitamin A, ginseng, dietary fiber, tooth brushing frequency, folate, and green tea consumption were associated with reduced GC risk. Conversely, Epstein-Barr virus infection, red meat, processed meat, intestinal metaplasia, gastric atrophy, a western-style diet, dietary cholesterol, dietary salt, and proton pump inhibitors were linked to higher GC risk.

Conclusion

This umbrella review identified 77 risk factors significantly associated with gastric cancer (GC), the majority of which are linked to personal traits and lifestyle behaviors. These findings enhance our understanding of GC etiology and can inform strategies to reduce incidence, delay progression, and alleviate the global burden.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023447199.

MeSH

Soy Foods, Eating, Vitamins, Meat, Neoplasms, Graves Disease, Aspirin, Diet, Food, Cholesterol, Cholesterol, Dietary, Risk Factors, Cholesterol, Hdl, Stomach Neoplasms, Infections