Background; The etiology of follicular lymphoma (FL), a common non-Hodgkin lymphoma subtype, is largely unknown.

Objective

We performed a systematic review and meta-analysis of observational studies examining the relationship between occupational exposures and FL risk.

Methods

We searched Ovid MEDLINE, Ovid EMBASE, and Web of Science for eligible observational studies examining job titles or occupational exposures prior to 1 January 2020. We performed a narrative synthesis and used random-effects models to generate meta-estimates of relative risk (RR) with 95% confidence intervals (95%CI) for exposures reported by three or more studies.

Results

Fifty-seven studies were eligible. Ten cohort and 36 case-control studies quantified FL risk in relation to any exposure to one or more occupational groups or agents. Eight cohort and 19 case-control studies examined dose-response relationships. We found evidence of a positive association with increasing plasma concentration of dichlorodiphenyldichloroethylene (DDE; meta-RR=1.51, 95%CI=0.99, 2.31; I²=0.0%) and polychlorinated biphenyls (PCBs; meta-RR=1.47, 95%CI=0.97, 2.24; I²=8.6%). We observed a positive association with exposure to any solvent (meta-RR=1.16, 95%CI=1.00, 1.34; I²=0.0%) and chlorinated solvents (meta-RR=1.35, 95%CI=1.09, 1.68; I²=0.0%). Single studies reported a significant positive dose-response association for exposure to any pesticide, hexachlorobenzene, any organophosphate, diazinon, metolachlor, carbaryl, lindane, trichloroethylene, oils/greases, and extremely low-frequency magnetic fields. Job title-only analyses suggested increased risk for medical doctors and spray painters, and decreased risk for bakers and teachers. Overall, studies demonstrated low risk of bias, but most studies examined small numbers of exposed cases.

Conclusions

Current evidence indicates a positive association between FL and occupational exposure to DDE, PCBs, any solvent and chlorinated solvents. Our findings may help guide policies and practices on the safe use of solvents and inform models of lymphomagenesis. Future studies with larger sample sizes and comprehensive quantitative exposure measures may elucidate other avoidable carcinogenic exposures.

中文翻译：

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对职业暴露和滤泡性淋巴瘤风险的系统评价和荟萃分析

背景; 滤泡性淋巴瘤（FL）是一种常见的非霍奇金淋巴瘤亚型，其病因学尚不清楚。

客观的

我们对观察性研究进行了系统的回顾和荟萃分析，以考察职业暴露与FL风险之间的关系。

方法

我们在Ovid MEDLINE，Ovid EMBASE和Web of Science中搜索了合格的观察性研究，以研究2020年1月1日之前的职位或职业暴露。我们进行了叙述性合成，并使用了随机效应模型来生成相对风险（RR）的荟萃估计三个或更多研究报告的暴露的置信区间为95％（95％CI）。

结果

五十七项研究符合条件。十项队列研究和36项病例对照研究量化了与暴露于一个或多个职业群体或代理商有关的FL风险。八项队列研究和19项病例对照研究检查了剂量反应关系。我们发现与二氯二苯基二氯乙烯（DDE; meta-RR = 1.51，95％CI = 0.99，2.31; I ² = 0.0％）和多氯联苯（PCBs; meta-RR = 1.47，95％）血浆浓度增加呈正相关的证据CI = 0.97，2.24；I ² = 8.6％）。我们观察到与暴露于任何溶剂（met-RR = 1.16，95％CI = 1.00，1.34; I ² = 0.0％）和氯化溶剂（meta-RR = 1.35，95％CI = 1.09，1.68; I ²= 0.0％）。一项单独的研究表明，暴露于任何农药，六氯苯，任何有机磷酸盐，二嗪农，异丙甲草胺，西维因，林丹，三氯乙烯，油/脂和极低频磁场下，剂量-反应显着正相关。仅职务职称的分析表明，医生和喷涂画家的风险增加，而面包师和教师的风险降低。总体而言，研究表明偏倚风险低，但是大多数研究都检查了少数暴露病例。

结论

当前证据表明FL与职业接触DDE，PCB，任何溶剂和氯化溶剂之间存在正相关。我们的发现可能有助于指导有关安全使用溶剂的政策和实践，并为淋巴瘤的形成提供信息。未来对更大样本量和全面定量暴露措施的研究可能会阐明其他可避免的致癌暴露。