title: Markers of systemic inflammation and colorectal adenoma risk: Meta-analysis of observational studies.
abstract: OBJECTIVE
  To perform a meta-analysis of observational studies on inflammatory markers levels and occurrence of colorectal adenoma.
  
  
  METHODS
  PubMed and EMBASE databases were searched until March 2016 for the articles reporting on the circulating levels of inflammatory markers, including: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and risk of colorectal adenoma. Random-effects models were used to calculate summary odds ratios (ORs) with 95%CIs for the highestvslowest category of exposure. Heterogeneity was assessed by using theQtest andI2statistic. Subgroup analyses were also performed to test for potential source of heterogeneity.
  
  
  RESULTS
  A total of 14 case-control studies were included. Ten studies on CRP including a total of 3350 cases and 4168 controls showed non-significant summary (OR = 1.23, 95%CI: 0.98-1.54;I2= 54%,Pheterogeneity= 0.01) in the general analysis, but significant increased odds when considering only advanced adenoma (OR = 1.59, 95%CI: 1.09-2.32;I2= 44%,Pheterogeneity= 0.15). Subgroup and stratified analyses revealed a potential influence of smoking status and aspirin use on the association between CRP levels and colorectal adenoma. Five studies examined the association between circulating levels of TNF-α and colorectal adenoma risk, including a total of 1,568 cases and 2,832 controls. The summary OR for the highestvsthe lowest category of exposure was 1.00 (95%CI: 0.77-1.29). The relationship between circulating IL-6 levels and colorectal adenoma risk was investigated in 7 studies including a total of 1936 cases and 3611 controls. The summary OR for the highestvsthe lowest category of exposure was 1.19 (95%CI: 0.92-1.55).
  
  
  CONCLUSIONS
  Summary of current evidence suggests a positive association of CRP levels and advanced colorectal adenoma risk. The role of potential confounding factors should be further evaluated.
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Justyna
authors.initials: J
authors.lastname: Godos
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Galvano
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Basile
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sciacca
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Giovannucci
authors.affiliation: Justyna Godos, Salvatore Sciacca, Giuseppe Grosso, Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero Universitaria Policlinico Vittorio Emanuele, 95123 Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Grosso
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D009367:Neoplasm Staging; D064887:Observational Studies as Topic; D016017:Odds Ratio; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein
keywords: C-reactive protein; Colorectal adenoma; Inflammatory markers; Interleukin-6; Meta-analysis; Tumor necrosis factor-alpha