Risk Assessment of Upper Tract Urothelial Carcinoma Related to Aristolochic Acid
A partir d'une revue systématique de la littérature, cette méta-analyse fait le point sur l'association entre carcinome urothélial des voies urinaires supérieures et une exposition à l'acide aristolochique présent dans des plantes utilisées en médecine traditionnelle chinoise
Background: Aristolochic acid (AA) is a toxin found in plants of the genus Aristolochia, to which humans can be exposed either through certain Chinese herbal medicines or through inadvertent commingling with food crops. Our objective was to estimate cumulative exposures of AA associated with increased risk of end stage renal disease (ESRD), and to conduct a systematic review and meta-analysis on AA-induced upper tract urothelial carcinoma (UUC). Methods: Using epidemiological studies on AA-related disease from multiple different world regions, a systematic review was performed in which relative risks, hazard ratios, and odds ratios were derived or extracted directly; and a meta-analysis was conducted. One study was used to estimate a benchmark dose lower confidence limit (BMDL) for AA-related ESRD. Results: Mean values for risk ratios - odds ratios, relative risks, or hazard ratios - of UUC caused by AA ranged from 1 to 49. A meta-analysis of these studies resulted in a pooled odds ratio of 5.97 (95% CI: 2.78-12.84) for this AA-related cancer. The obtained BMDL for AA-related ESRD was 0.42 g cumulative aristolochic acid exposure. Conclusions: Aristolochic acid exposure is significantly associated with an increased risk of UUC, and there is a dose-dependent relationship between cumulative AA exposure and end stage renal disease risk. Impact: Individuals who use certain Chinese herbal medicines may significantly increase their risk of developing UUC and/or ESRD, as would individuals who are inadvertently exposed to aristolochic acid through commingling of Aristolochia plants with harvested food crops.