Mourino, NereaVarela-Lema, LeonorRuano-Ravina, AlbertoPeiteado, CristinaCandal-Pedreira, CristinaRey-Brandariz, JuliaTorres-Cadavid, ElianaGarcía, GuadalupePérez-Ríos, Mónica2025-03-262025-03-262024-02-18Mourino N, Varela-Lema L, Ruano-Ravina A, Peiteado C, Candal-Pedreira C, Rey-Brandariz J, Torres-Cadavid E, García G, Pérez-Ríos M. Occupational exposure to endotoxins and small cell lung cancer: a systematic review with meta-analysis. J Toxicol Environ Health B Crit Rev. 2024 Apr 2;27(3):91-1051093-7404http://hdl.handle.net/2183/41542Meta-Analysis[Abstract] The relationship of occupational exposure to endotoxins with different histologic subtypes of lung cancer has not been established. Our objective was to conduct a systematic review with meta-analysis to assess the effect of exposure to endotoxins on the development of small cell lung cancer (SCLC). A bibliographic search was conducted using MEDLINE, Embase, CENTRAL, and Web of Science databases until December 2022, including all cohort and/or case-control studies that examined occupational exposure to endotoxins and SCLC. Risk of bias was assessed using the U.S. Office of Health Assessment and Translation tool. A random effects model was applied, publication bias were assessed, and a sensitivity analysis was conducted. Four papers were selected for meta-analysis purposes. A total of 144 incident cases of SCLC and 897 population or hospital controls were included. Occupational exposure to endotoxins was considered for textile/leather industry and agricultural sector workers exposed to endotoxins originating from wool, cotton, or leather dust. Except for one study, all investigations were classified as having a low probability of risk of biases. The results of the meta-analysis were not statistically significant (pooled OR: 0.86; 95% CI:0.69-1.08). In addition, neither between-study heterogeneity (I2=0%;p=0.92) nor publication bias was observed (p=0.49). The results of the sensitivity analysis, after including five studies that assessed the risk of SCLC among textile industry and crop/livestock farm workers (not specifically exposed to endotoxins), showed a negative statistically non-significant association and low between-study heterogeneity (pooled OR: 0.90; 95% CI:0.79-1.02; I2=22%;p=0.23). Subjects exposed to occupational exposure to endotoxins seem to exhibit a negative association with the development of SCLC, although the results are not conclusive.engThis is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Toxicology and Environmental Health, Part B on 2024, available at Taylor & Francis online.Occupational exposureCase–control studiesEndotoxinsMeta-analysisSmall cell carcinomareviewopen access10.1080/10937404.2024.2316151