Abstract：
Occupational exposure to carcinogens of increasing cancer risk have been extensively suggested. A robust assessment of these evidence is needed to guide public policy and health care. We aimed to classify the strength of evidence for associations of 13 occupational carcinogens (OCs) and risk of cancers. We searched PubMed and Web of Science up to November 2022 to identify potentially relevant studies. We graded the evidence into convincing, highly suggestive, suggestive, weak, or not significant according to a standardized classification based on: random-effects p value, number of cancer cases, 95% confidence interval of largest study, heterogeneity between studies, 95% prediction interval, small study effect, excess significance bias and sensitivity analyses with credibility ceilings. The quality of meta-analysis was evaluated by AMSTAR 2. Forty-eight articles yielded 79 meta-analyses were included in current umbrella review. Evidence of associations were convincing (class I) or highly suggeastive (class II) for asbestos exposure and increasing risk of lung cancer among smokers (RR = 8.79, 95%CI: 5.81-13.25 for cohort studies and OR = 8.68, 95%CI: 5.68-13.24 for case-control studies), asbestos exposure and increasing risk of mesothelioma (RR = 4.61, 95%CI: 2.57-8.26), and formaldehyde exposure and increasing risk of sinonasal cancer (RR = 1.68, 95%CI: 1.38-2.05). Fifteen associations were supported by suggestive evidence (class III). In summary, the current umbrella review found strong associations between: asbestos exposure and increasing risk of lung cancer among smokers; asbestos exposure and increasing risk of mesothelioma; and formaldehyde exposure and higher risk of sinonasal cancer. Other associations might be genuine, but substantial uncertainty remains.
摘要：
已广泛建议职业暴露于致癌物会增加癌症风险。需要对这些证据进行强有力的评估，以指导公共政策和医疗保健。我们旨在对13种职业性致癌物（OC）与癌症风险关联的证据强度进行分类。我们搜索了截至2022年11月的PubMed和WebofScience，以确定潜在的相关研究。我们把证据定格为有说服力,高度暗示性，暗示,弱,根据基于随机效应p值的标准化分类，或不显著，癌症病例数,最大研究的95%置信区间，研究之间的异质性，95%预测区间,小的研究效果，具有可信度上限的过度显著性偏差和敏感性分析。通过AMSTAR2评估荟萃分析的质量。48篇文章产生了79项荟萃分析，纳入了当前的综述。相关证据对石棉暴露和吸烟者肺癌风险增加具有说服力（I类）或高度暗示性（II类）（队列研究RR=8.79，95CI：5.81-13.25，病例对照研究OR=8.68，95CI：5.68-13.24），石棉暴露和间皮瘤风险增加（RR=4.61，95CI：2.57-8.26），甲醛暴露与鼻窦癌风险增加（RR=1.68，95CI：1.38-2.05）。15个协会得到了暗示性证据（III类）的支持。总之,目前的综述发现:石棉暴露与吸烟者肺癌风险增加;石棉暴露与间皮瘤风险增加;甲醛暴露与鼻窦癌风险增加之间存在密切关联.其他协会可能是真实的，但仍存在很大的不确定性。
