{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:37:26Z","timestamp":1786466246959,"version":"build-2736575974"},"reference-count":62,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82504487"],"award-info":[{"award-number":["82504487"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004731","name":"Natural Science Foundation of Zhejiang Province","doi-asserted-by":"publisher","award":["LQN25H260001"],"award-info":[{"award-number":["LQN25H260001"]}],"id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017594","name":"Medical Science and Technology Project of Zhejiang Province","doi-asserted-by":"publisher","award":["2024KY050; 2025KY043"],"award-info":[{"award-number":["2024KY050; 2025KY043"]}],"id":[{"id":"10.13039\/501100017594","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardia gastric cancer (CGC) is a distinct and increasingly prevalent malignancy, yet the role of air pollution in its sequential carcinogenesis remains unclear. The present cross-sectional study aimed to evaluate the associations between long-term exposure to ambient air pollution and the progression of precancerous cardia gastric lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 99,493 participants were enrolled from the National Opportunistic Screening Program for Upper Gastrointestinal Cancer in Zhejiang Province of China from 2022 to 2023. Long-term exposure to six air pollutants including particulate matter (PM\n                      <jats:sub>10<\/jats:sub>\n                      ), fine particulate matter (PM\n                      <jats:sub>2.5<\/jats:sub>\n                      ), sulfur dioxide (SO\n                      <jats:sub>2<\/jats:sub>\n                      ), nitrogen dioxide (NO\n                      <jats:sub>2<\/jats:sub>\n                      ), ozone (O\n                      <jats:sub>3<\/jats:sub>\n                      ), and carbon monoxide (CO) was assessed by using ChinaHighAirPollutants (CHAP) dataset. Cardia lesion progression was classified into five histopathological stages based on endoscopic biopsy. Ordinal logistic regression was used to examine pollutant-specific associations, restricted cubic splines (RCS) were applied to assess the potential exposure\u2013response associations, and weighted quantile sum (WQS) regression was performed to evaluate the mixture effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All six pollutants were significantly associated with cardia lesion progression. The adjusted odds ratios (95% confidence intervals, 95% CI) per standard deviation increment in 5-year mean concentration were 1.21 (1.17\u20131.25) for PM\n                      <jats:sub>10<\/jats:sub>\n                      , 1.28 (1.23\u20131.32) for PM\n                      <jats:sub>2.5<\/jats:sub>\n                      , 1.17 (1.13\u20131.21) for SO\n                      <jats:sub>2<\/jats:sub>\n                      , 1.07 (1.03\u20131.10) for NO\n                      <jats:sub>2<\/jats:sub>\n                      , 1.16 (1.12\u20131.20) for O\n                      <jats:sub>3<\/jats:sub>\n                      , and 1.36 (1.30\u20131.41) for CO. RCS analyses indicated non-linear exposure\u2013response patterns for NO\n                      <jats:sub>2<\/jats:sub>\n                      , O\n                      <jats:sub>3<\/jats:sub>\n                      , and CO. In mixture models, CO and PM\n                      <jats:sub>2.5<\/jats:sub>\n                      were identified as the predominant contributors, with a 10% increase in combined exposure associated with a 10% (95% CI: 7\u201313%) higher risk of cardia lesion progression. Effect modification analysis revealed that\n                      <jats:italic>Helicobacter pylori<\/jats:italic>\n                      -positive individuals were more susceptible to pollution-related progression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term exposure to air pollutants is associated with the progression of cardia gastric lesions, highlighting the importance of incorporating air quality improvement into cancer prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-025-04582-1","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T06:16:18Z","timestamp":1766384178000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Long-term exposure to ambient air pollution and sequential carcinogenesis in the cardia gastric: a cross-sectional study"],"prefix":"10.1186","volume":"23","author":[{"given":"Juan","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huanqing","family":"Tao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sainan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingbin","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"4582_CR1","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s10120-016-0663-8","volume":"20","author":"H Yamashita","year":"2017","unstructured":"Yamashita H, Seto Y, Sano T, Makuuchi H, Ando N, et al. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer. 2017;20:69\u201383. https:\/\/doi.org\/10.1007\/s10120-016-0663-8.","journal-title":"Gastric Cancer"},{"key":"4582_CR2","doi-asserted-by":"publisher","first-page":"e888","DOI":"10.1016\/S2468-2667(21)00164-X","volume":"6","author":"L Yang","year":"2021","unstructured":"Yang L, Kartsonaki C, Yao P, De Martel C, Plummer M, Chapman D, et al. The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort study. Lancet Public Health. 2021;6:e888\u201396. https:\/\/doi.org\/10.1016\/S2468-2667(21)00164-X.","journal-title":"Lancet Public Health"},{"key":"4582_CR3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.semradonc.2012.09.008","volume":"23","author":"MF Buas","year":"2013","unstructured":"Buas MF, Vaughan TL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol. 2013;23:3\u20139. https:\/\/doi.org\/10.1016\/j.semradonc.2012.09.008.","journal-title":"Semin Radiat Oncol"},{"key":"4582_CR4","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1038\/s41571-023-00747-0","volume":"20","author":"AP Thrift","year":"2023","unstructured":"Thrift AP, Wenker TN, El-Serag HB. Global burden of gastric cancer: epidemiological trends, risk factors, screening and prevention. Nat Rev Clin Oncol. 2023;20:338\u201349. https:\/\/doi.org\/10.1038\/s41571-023-00747-0.","journal-title":"Nat Rev Clin Oncol"},{"issue":"3","key":"4582_CR5","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;caac.21834. https:\/\/doi.org\/10.3322\/caac.21834.","journal-title":"CA Cancer J Clin"},{"key":"4582_CR6","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1053\/j.gastro.2020.02.068","volume":"159","author":"M Arnold","year":"2020","unstructured":"Arnold M, Abnet CC, Neale RE, Vignat J, Giovannucci EL, McGlynn KA, et al. Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020;159:335-349.e15. https:\/\/doi.org\/10.1053\/j.gastro.2020.02.068.","journal-title":"Gastroenterology"},{"key":"4582_CR7","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1136\/gutjnl-2020-321600","volume":"69","author":"M Arnold","year":"2020","unstructured":"Arnold M, Ferlay J, Van Berge Henegouwen MI, Soerjomataram I. Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut. 2020;69:1564\u201371. https:\/\/doi.org\/10.1136\/gutjnl-2020-321600.","journal-title":"Gut"},{"key":"4582_CR8","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1093\/annonc\/mdr384","volume":"23","author":"CA Gonz\u00e1lez","year":"2012","unstructured":"Gonz\u00e1lez CA, Megraud F, Buissonniere A, Lujan Barroso L, Agudo A, Duell EJ, et al. Helicobacter pylori infection assessed by ELISA and by immunoblot and noncardia gastric cancer risk in a prospective study: the Eurgast-EPIC project. Ann Oncol. 2012;23:1320\u20134. https:\/\/doi.org\/10.1093\/annonc\/mdr384.","journal-title":"Ann Oncol"},{"key":"4582_CR9","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s10552-010-9707-2","volume":"22","author":"M Cavaleiro-Pinto","year":"2011","unstructured":"Cavaleiro-Pinto M, Peleteiro B, Lunet N, Barros H. Helicobacter pylori infection and gastric cardia cancer: systematic review and meta-analysis. Cancer Causes Control. 2011;22:375\u201387. https:\/\/doi.org\/10.1007\/s10552-010-9707-2.","journal-title":"Cancer Causes Control"},{"key":"4582_CR10","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1186\/s12916-024-03596-5","volume":"22","author":"H Zhou","year":"2024","unstructured":"Zhou H, Hong F, Wang L, Tang X, Guo B, Luo Y, et al. Air pollution and risk of 32 health conditions: outcome-wide analyses in a population-based prospective cohort in Southwest China. BMC Med. 2024;22:370. https:\/\/doi.org\/10.1186\/s12916-024-03596-5.","journal-title":"BMC Med"},{"key":"4582_CR11","doi-asserted-by":"publisher","first-page":"460","DOI":"10.3322\/caac.21632","volume":"70","author":"MC Turner","year":"2020","unstructured":"Turner MC, Andersen ZJ, Baccarelli A, Diver WR, Gapstur SM, Pope CA, et al. Outdoor air pollution and cancer: an overview of the current evidence and public health recommendations. CA Cancer J Clin. 2020;70:460\u201379. https:\/\/doi.org\/10.3322\/caac.21632.","journal-title":"CA Cancer J Clin"},{"key":"4582_CR12","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1016\/j.chest.2018.10.041","volume":"155","author":"DE Schraufnagel","year":"2019","unstructured":"Schraufnagel DE, Balmes JR, Cowl CT, De Matteis S, Jung S-H, Mortimer K, et al. Air pollution and noncommunicable diseases. Chest. 2019;155:417\u201326. https:\/\/doi.org\/10.1016\/j.chest.2018.10.041.","journal-title":"Chest"},{"key":"4582_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2025.137619","volume":"489","author":"D Peng","year":"2025","unstructured":"Peng D, Liu X-Y, Sheng Y-H, Li S-Q, Zhang D, Chen B, et al. Ambient air pollution and the risk of cancer: evidence from global cohort studies and epigenetic-related causal inference. J Hazard Mater. 2025;489:137619. https:\/\/doi.org\/10.1016\/j.jhazmat.2025.137619.","journal-title":"J Hazard Mater"},{"key":"4582_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.105676","volume":"138","author":"M Elten","year":"2020","unstructured":"Elten M, Benchimol EI, Fell DB, Kuenzig ME, Smith G, Chen H, et al. Ambient air pollution and the risk of pediatric-onset inflammatory bowel disease: a population-based cohort study. Environ Int. 2020;138:105676. https:\/\/doi.org\/10.1016\/j.envint.2020.105676.","journal-title":"Environ Int"},{"key":"4582_CR15","doi-asserted-by":"publisher","first-page":"15511","DOI":"10.1021\/acs.est.4c06035","volume":"58","author":"B Liu","year":"2024","unstructured":"Liu B, Wang G, Wang L, Yan J, Zhu K, Liu Q, et al. Unraveling cross-organ impacts of airborne pollutants: a multiomics study on respiratory exposure and gastrointestinal health. Environ Sci Technol. 2024;58:15511\u201321. https:\/\/doi.org\/10.1021\/acs.est.4c06035.","journal-title":"Environ Sci Technol"},{"key":"4582_CR16","doi-asserted-by":"publisher","first-page":"21489","DOI":"10.1021\/acs.est.4c10986","volume":"58","author":"L Yang","year":"2024","unstructured":"Yang L, Kang N, Wang N, Zhang X, Liu S, Li H, et al. <article-title update=\"added\"> Specifying the associations between PM 2.5 constituents and gastrointestinal cancer incidence: findings from a prospective cohort study in Beijing, China. Environ Sci Technol. 2024;58:21489\u201398. https:\/\/doi.org\/10.1021\/acs.est.4c10986.","journal-title":"Environ Sci Technol"},{"key":"4582_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.105126","volume":"103","author":"F Jiang","year":"2024","unstructured":"Jiang F, Zhao J, Sun J, Chen W, Zhao Y, Zhou S, et al. Impact of ambient air pollution on colorectal cancer risk and survival: insights from a prospective cohort and epigenetic Mendelian randomization study. EBioMedicine. 2024;103:105126. https:\/\/doi.org\/10.1016\/j.ebiom.2024.105126.","journal-title":"EBioMedicine"},{"key":"4582_CR18","doi-asserted-by":"publisher","first-page":"e519","DOI":"10.1016\/S1470-2045(20)30448-4","volume":"21","author":"RA Hiatt","year":"2020","unstructured":"Hiatt RA, Beyeler N. Cancer and climate change. Lancet Oncol. 2020;21:e519-27. https:\/\/doi.org\/10.1016\/S1470-2045(20)30448-4.","journal-title":"Lancet Oncol"},{"key":"4582_CR19","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1038\/s41586-023-05874-3","volume":"616","author":"W Hill","year":"2023","unstructured":"Hill W, Lim EL, Weeden CE, Lee C, Augustine M, Chen K, et al. Lung adenocarcinoma promotion by air pollutants. Nature. 2023;616:159\u201367. https:\/\/doi.org\/10.1038\/s41586-023-05874-3.","journal-title":"Nature"},{"key":"4582_CR20","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1016\/S0140-6736(13)62158-3","volume":"383","author":"R Beelen","year":"2014","unstructured":"Beelen R, Raaschou-Nielsen O, Stafoggia M, Andersen ZJ, Weinmayr G, Hoffmann B, et al. Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet. 2014;383:785\u201395. https:\/\/doi.org\/10.1016\/S0140-6736(13)62158-3.","journal-title":"Lancet"},{"key":"4582_CR21","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1002\/ijc.31564","volume":"143","author":"G Nagel","year":"2018","unstructured":"Nagel G, Stafoggia M, Pedersen M, Andersen ZJ, Galassi C, Munkenast J, et al. Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Int J Cancer. 2018;143:1632\u201343. https:\/\/doi.org\/10.1002\/ijc.31564.","journal-title":"Int J Cancer"},{"key":"4582_CR22","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.jes.2019.09.025","volume":"89","author":"J Yin","year":"2020","unstructured":"Yin J, Wu X, Li S, Li C, Guo Z. Impact of environmental factors on gastric cancer: a review of the scientific evidence, human prevention and adaptation. J Environ Sci. 2020;89:65\u201379. https:\/\/doi.org\/10.1016\/j.jes.2019.09.025.","journal-title":"J Environ Sci"},{"key":"4582_CR23","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.envint.2018.07.030","volume":"120","author":"G Weinmayr","year":"2018","unstructured":"Weinmayr G, Pedersen M, Stafoggia M, Andersen ZJ, Galassi C, Munkenast J, et al. Particulate matter air pollution components and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts of Air Pollution Effects (ESCAPE). Environ Int. 2018;120:163\u201371. https:\/\/doi.org\/10.1016\/j.envint.2018.07.030.","journal-title":"Environ Int"},{"key":"4582_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.105640","volume":"138","author":"C Guo","year":"2020","unstructured":"Guo C, Chan T-C, Teng Y-C, Lin C, Bo Y, Chang L, et al. Long-term exposure to ambient fine particles and gastrointestinal cancer mortality in Taiwan: a cohort study. Environ Int. 2020;138:105640. https:\/\/doi.org\/10.1016\/j.envint.2020.105640.","journal-title":"Environ Int"},{"key":"4582_CR25","doi-asserted-by":"publisher","first-page":"22353","DOI":"10.1007\/s11356-020-08628-0","volume":"27","author":"CJ Ethan","year":"2020","unstructured":"Ethan CJ, Mokoena KK, Yu Y, Shale K, Fan Y, Rong J, et al. Association between PM2.5 and mortality of stomach and colorectal cancer in Xi\u2019an: a time-series study. Environ Sci Pollut Res Int. 2020;27:22353\u201363. https:\/\/doi.org\/10.1007\/s11356-020-08628-0.","journal-title":"Environ Sci Pollut Res Int"},{"key":"4582_CR26","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s12916-023-02734-9","volume":"21","author":"M Cai","year":"2023","unstructured":"Cai M, Wei J, Zhang S, Liu W, Wang L, Qian Z, et al. Short-term air pollution exposure associated with death from kidney diseases: a nationwide time-stratified case-crossover study in China from 2015 to 2019. BMC Med. 2023;21:32. https:\/\/doi.org\/10.1186\/s12916-023-02734-9.","journal-title":"BMC Med"},{"key":"4582_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2022.159104","volume":"856","author":"M Cai","year":"2023","unstructured":"Cai M, Lin X, Wang X, Zhang S, Qian Z, McMillin SE, et al. Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China: a cohort study of 1.07 million stroke patients. Sci Total Environ. 2023;856:159104. https:\/\/doi.org\/10.1016\/j.scitotenv.2022.159104.","journal-title":"Sci Total Environ"},{"key":"4582_CR28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2025.138105","volume":"492","author":"Y Chen","year":"2025","unstructured":"Chen Y, Xu Z, Guo Y, Li S, Wang YA, Gasevic D. Air pollution increases the risk of frailty: China Health and Retirement Longitudinal Study (CHARLS). J Hazard Mater. 2025;492:138105. https:\/\/doi.org\/10.1016\/j.jhazmat.2025.138105.","journal-title":"J Hazard Mater"},{"key":"4582_CR29","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/s13253-014-0180-3","volume":"20","author":"C Carrico","year":"2015","unstructured":"Carrico C, Gennings C, Wheeler DC, Factor-Litvak P. Characterization of weighted quantile sum regression for highly correlated data in a risk analysis setting. JABES. 2015;20:100\u201320. https:\/\/doi.org\/10.1007\/s13253-014-0180-3.","journal-title":"JABES"},{"key":"4582_CR30","doi-asserted-by":"publisher","first-page":"15882","DOI":"10.1021\/acs.est.2c03715","volume":"56","author":"Y Hu","year":"2022","unstructured":"Hu Y, Ji JS, Zhao B. Deaths attributable to indoor PM2.5 in urban China when outdoor air meets 2021 WHO air quality guidelines. Environ Sci Technol. 2022;56:15882\u201391. https:\/\/doi.org\/10.1021\/acs.est.2c03715.","journal-title":"Environ Sci Technol"},{"key":"4582_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2025.109378","volume":"198","author":"X Ma","year":"2025","unstructured":"Ma X, Morawska L, Zou B, Gao J, Deng J, Wang X, et al. Towards compliance with the 2021 WHO air quality guidelines: a comparative analysis of PM2.5 trends in australia and China. Environ Int. 2025;198:109378. https:\/\/doi.org\/10.1016\/j.envint.2025.109378.","journal-title":"Environ Int"},{"key":"4582_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2024.118182","volume":"247","author":"J Li","year":"2024","unstructured":"Li J, He C, Ying J, Hua B, Yang Y, Chen W, et al. Air pollutants, genetic susceptibility, and the risk of incident gastrointestinal diseases: a large prospective cohort study. Environ Res. 2024;247:118182. https:\/\/doi.org\/10.1016\/j.envres.2024.118182.","journal-title":"Environ Res"},{"key":"4582_CR33","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1002\/ijc.34864","volume":"154","author":"G Nagel","year":"2024","unstructured":"Nagel G, Chen J, Jaensch A, Skodda L, Rodopoulou S, Strak M, et al. Long-term exposure to air pollution and incidence of gastric and the upper aerodigestive tract cancers in a pooled European cohort: the ELAPSE project. Int J Cancer. 2024;154:1900\u201310. https:\/\/doi.org\/10.1002\/ijc.34864.","journal-title":"Int J Cancer"},{"key":"4582_CR34","doi-asserted-by":"publisher","DOI":"10.1289\/EHP9620","volume":"130","author":"N Pritchett","year":"2022","unstructured":"Pritchett N, Spangler EC, Gray GM, Livinski AA, Sampson JN, Dawsey SM, et al. Exposure to outdoor particulate matter air pollution and risk of gastrointestinal cancers in adults: a systematic review and meta-analysis of epidemiologic evidence. Environ Health Perspect. 2022;130:036001. https:\/\/doi.org\/10.1289\/EHP9620.","journal-title":"Environ Health Perspect"},{"key":"4582_CR35","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1136\/gut.49.3.347","volume":"49","author":"Helicobacter And Cancer Collaborative Group","year":"2001","unstructured":"Helicobacter And Cancer Collaborative Group. Gastric cancer and Helicobacter pylori: a combined analysis of 12 case-control studies nested within prospective cohorts. Gut. 2001;49:347\u201353. https:\/\/doi.org\/10.1136\/gut.49.3.347.","journal-title":"Gut"},{"key":"4582_CR36","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.canlet.2008.02.030","volume":"266","author":"P M\u00f8ller","year":"2008","unstructured":"M\u00f8ller P, Folkmann JK, Forchhammer L, Br\u00e4uner EV, Danielsen PH, Risom L, et al. Air pollution, oxidative damage to DNA, and carcinogenesis. Cancer Lett. 2008;266:84\u201397. https:\/\/doi.org\/10.1016\/j.canlet.2008.02.030.","journal-title":"Cancer Lett"},{"key":"4582_CR37","doi-asserted-by":"publisher","DOI":"10.1289\/EHP7089","volume":"129","author":"S Tripathy","year":"2021","unstructured":"Tripathy S, Marsland AL, Kinnee EJ, Tunno BJ, Manuck SB, Gianaros PJ, et al. Long-term ambient air pollution exposures and circulating and stimulated inflammatory mediators in a cohort of midlife adults. Environ Health Perspect. 2021;129:057007. https:\/\/doi.org\/10.1289\/EHP7089.","journal-title":"Environ Health Perspect"},{"key":"4582_CR38","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1038\/s41590-020-0802-6","volume":"21","author":"T Suzuki","year":"2020","unstructured":"Suzuki T, Hidaka T, Kumagai Y, Yamamoto M. Environmental pollutants and the immune response. Nat Immunol. 2020;21:1486\u201395. https:\/\/doi.org\/10.1038\/s41590-020-0802-6.","journal-title":"Nat Immunol"},{"key":"4582_CR39","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2020.109485","volume":"186","author":"CE Dujardin","year":"2020","unstructured":"Dujardin CE, Mars RAT, Manemann SM, Kashyap PC, Clements NS, Hassett LC, et al. Impact of air quality on the gastrointestinal microbiome: a review. Environ Res. 2020;186:109485. https:\/\/doi.org\/10.1016\/j.envres.2020.109485.","journal-title":"Environ Res"},{"key":"4582_CR40","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1021\/acssensors.8b01672","volume":"4","author":"L Zheng","year":"2019","unstructured":"Zheng L, Dong H, Zhao W, Zhang X, Duan X, Zhang H, et al. An air\u2013liquid interface organ-level lung microfluidics platform for analysis on molecular mechanisms of cytotoxicity induced by cancer-causing fine particles. ACS Sens. 2019;4:907\u201317. https:\/\/doi.org\/10.1021\/acssensors.8b01672.","journal-title":"ACS Sens"},{"key":"4582_CR41","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.advms.2016.12.003","volume":"62","author":"B Yang","year":"2017","unstructured":"Yang B, Li X, Chen D, Xiao C. Effects of fine air particulates on gene expression in non-small-cell lung cancer. Adv Med Sci. 2017;62:295\u2013301. https:\/\/doi.org\/10.1016\/j.advms.2016.12.003.","journal-title":"Adv Med Sci"},{"key":"4582_CR42","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.chemosphere.2017.08.076","volume":"188","author":"MS Peixoto","year":"2017","unstructured":"Peixoto MS, De Oliveira Galv\u00e3o MF, Batistuzzo De Medeiros SR. Cell death pathways of particulate matter toxicity. Chemosphere. 2017;188:32\u201348. https:\/\/doi.org\/10.1016\/j.chemosphere.2017.08.076.","journal-title":"Chemosphere"},{"key":"4582_CR43","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1016\/S1470-2045(12)70280-2","volume":"13","author":"L Benbrahim-Tallaa","year":"2012","unstructured":"Benbrahim-Tallaa L, Baan RA, Grosse Y, Lauby-Secretan B, El Ghissassi F, Bouvard V, et al. Carcinogenicity of diesel-engine and gasoline-engine exhausts and some nitroarenes. Lancet Oncol. 2012;13:663\u20134. https:\/\/doi.org\/10.1016\/S1470-2045(12)70280-2.","journal-title":"Lancet Oncol"},{"key":"4582_CR44","doi-asserted-by":"publisher","first-page":"1215","DOI":"10.1080\/15287394.2011.590100","volume":"74","author":"H-F Chiu","year":"2011","unstructured":"Chiu H-F, Tsai S-S, Chen P-S, Liao Y-H, Liou S-H, Wu T-N, et al. Traffic air pollution and risk of death from gastric cancer in Taiwan: petrol station density as an indicator of air pollutant exposure. J Toxicol Environ Health. 2011;74:1215\u201324. https:\/\/doi.org\/10.1080\/15287394.2011.590100.","journal-title":"J Toxicol Environ Health"},{"key":"4582_CR45","doi-asserted-by":"publisher","first-page":"15825","DOI":"10.1021\/acs.est.3c04056","volume":"57","author":"J Guo","year":"2023","unstructured":"Guo J, Zhou J, Han R, Wang Y, Lian X, Tang Z, et al. Association of short-term co-exposure to particulate matter and ozone with mortality risk. Environ Sci Technol. 2023;57:15825\u201334. https:\/\/doi.org\/10.1021\/acs.est.3c04056.","journal-title":"Environ Sci Technol"},{"key":"4582_CR46","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2025.137116","volume":"487","author":"S Wu","year":"2025","unstructured":"Wu S, Zhang X, Lu Y, Ma Y, Qi X, Wang X, et al. SO2 derivatives impair ovarian function by inhibiting Serpine1\/NF-\u03baB pathway-mediated ovarian granulosa cell survival. J Hazard Mater. 2025;487:137116. https:\/\/doi.org\/10.1016\/j.jhazmat.2025.137116.","journal-title":"J Hazard Mater"},{"key":"4582_CR47","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106434","volume":"150","author":"P Orellano","year":"2021","unstructured":"Orellano P, Reynoso J, Quaranta N. Short-term exposure to sulphur dioxide (SO2) and all-cause and respiratory mortality: a systematic review and meta-analysis. Environ Int. 2021;150:106434. https:\/\/doi.org\/10.1016\/j.envint.2021.106434.","journal-title":"Environ Int"},{"key":"4582_CR48","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbadis.2024.167446","volume":"1870","author":"C Cardoso-Pires","year":"2024","unstructured":"Cardoso-Pires C, Vieira HLA. Carbon monoxide and mitochondria: cell energy and fate control. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 2024;1870:167446. https:\/\/doi.org\/10.1016\/j.bbadis.2024.167446.","journal-title":"Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease"},{"key":"4582_CR49","doi-asserted-by":"publisher","first-page":"6058","DOI":"10.1038\/s41388-021-01989-x","volume":"40","author":"X Xia","year":"2021","unstructured":"Xia X, Wang S, Ni B, Xing S, Cao H, Zhang Z, et al. Correction to: hypoxic gastric cancer-derived exosomes promote progression and metastasis via MiR-301a-3p\/PHD3\/HIF-1\u03b1 positive feedback loop. Oncogene. 2021;40:6058\u20136058. https:\/\/doi.org\/10.1038\/s41388-021-01989-x.","journal-title":"Oncogene"},{"key":"4582_CR50","doi-asserted-by":"publisher","DOI":"10.1016\/j.ese.2024.100515","volume":"23","author":"Y Hao","year":"2025","unstructured":"Hao Y, Xu L, Peng M, Yang Z, Wang W, Meng F. Synergistic air pollution exposure elevates depression risk: a cohort study. Environ Sci Ecotechnol. 2025;23:100515. https:\/\/doi.org\/10.1016\/j.ese.2024.100515.","journal-title":"Environ Sci Ecotechnol"},{"key":"4582_CR51","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2021.150515","volume":"806","author":"HH Shin","year":"2022","unstructured":"Shin HH, Maquiling A, Thomson EM, Park I-W, Stieb DM, Dehghani P. Sex-difference in air pollution-related acute circulatory and respiratory mortality and hospitalization. Sci Total Environ. 2022;806:150515. https:\/\/doi.org\/10.1016\/j.scitotenv.2021.150515.","journal-title":"Sci Total Environ"},{"key":"4582_CR52","doi-asserted-by":"publisher","first-page":"3119","DOI":"10.1158\/0008-5472.CAN-04-0166","volume":"64","author":"Y Tsuchiya","year":"2004","unstructured":"Tsuchiya Y, Nakajima M, Kyo S, Kanaya T, Inoue M, Yokoi T. Human CYP1B1 is regulated by estradiol via estrogen receptor. Cancer Res. 2004;64:3119\u201325. https:\/\/doi.org\/10.1158\/0008-5472.CAN-04-0166.","journal-title":"Cancer Res"},{"key":"4582_CR53","doi-asserted-by":"publisher","DOI":"10.1172\/JCI177242","volume":"134","author":"NU Chowdhury","year":"2024","unstructured":"Chowdhury NU, Cephus J-Y, Henriquez Pilier E, Wolf MM, Madden MZ, Kuehnle SN, et al. Androgen signaling restricts glutaminolysis to drive sex-specific Th17 metabolism in allergic airway inflammation. J Clin Invest. 2024;134:e177242. https:\/\/doi.org\/10.1172\/JCI177242.","journal-title":"J Clin Invest"},{"key":"4582_CR54","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1210\/endrev\/bnac017","volume":"44","author":"B Chakraborty","year":"2023","unstructured":"Chakraborty B, Byemerwa J, Krebs T, Lim F, Chang C-Y, McDonnell DP. Estrogen receptor signaling in the immune system. Endocr Rev. 2023;44:117\u201341. https:\/\/doi.org\/10.1210\/endrev\/bnac017.","journal-title":"Endocr Rev"},{"key":"4582_CR55","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhazmat.2024.135584","volume":"478","author":"C Lu","year":"2024","unstructured":"Lu C, Deng W, Qiao Z, Sun W, Yang W, Liu Z, et al. Childhood Helicobacter pylori infection: impacts of environmental exposures and parental stress. J Hazard Mater. 2024;478:135584. https:\/\/doi.org\/10.1016\/j.jhazmat.2024.135584.","journal-title":"J Hazard Mater"},{"key":"4582_CR56","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1053\/j.gastro.2005.03.037","volume":"128","author":"J Houghton","year":"2005","unstructured":"Houghton J, Wang TC. Helicobacter pylori and gastric cancer: a new paradigm for inflammation-associated epithelial cancers. Gastroenterology. 2005;128:1567\u201378. https:\/\/doi.org\/10.1053\/j.gastro.2005.03.037.","journal-title":"Gastroenterology"},{"key":"4582_CR57","doi-asserted-by":"publisher","first-page":"e996","DOI":"10.1016\/S2468-2667(23)00186-X","volume":"8","author":"C Xia","year":"2023","unstructured":"Xia C, Basu P, Kramer BS, Li H, Qu C, Yu XQ, et al. Cancer screening in China: a steep road from evidence to implementation. The Lancet Public Health. 2023;8:e996-1005. https:\/\/doi.org\/10.1016\/S2468-2667(23)00186-X.","journal-title":"The Lancet Public Health"},{"key":"4582_CR58","doi-asserted-by":"publisher","DOI":"10.1093\/nsr\/nwad263","volume":"11","author":"T Xue","year":"2024","unstructured":"Xue T, Wang R, Wang M, Wang Y, Tong D, Meng X, et al. Health benefits from the rapid reduction in ambient exposure to air pollutants after China\u2019s clean air actions: progress in efficacy and geographic equality. Natl Sci Rev. 2024;11:nwad263. https:\/\/doi.org\/10.1093\/nsr\/nwad263.","journal-title":"Natl Sci Rev"},{"key":"4582_CR59","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1016\/j.oneear.2023.07.007","volume":"6","author":"J Cheng","year":"2023","unstructured":"Cheng J, Tong D, Liu Y, Geng G, Davis SJ, He K, et al. A synergistic approach to air pollution control and carbon neutrality in China can avoid millions of premature deaths annually by 2060. One Earth. 2023;6:978\u201389. https:\/\/doi.org\/10.1016\/j.oneear.2023.07.007.","journal-title":"One Earth"},{"key":"4582_CR60","doi-asserted-by":"publisher","first-page":"6491","DOI":"10.1038\/s41467-023-42089-6","volume":"14","author":"D Wu","year":"2023","unstructured":"Wu D, Zheng H, Li Q, Wang S, Zhao B, Jin L, et al. Achieving health-oriented air pollution control requires integrating unequal toxicities of industrial particles. Nat Commun. 2023;14:6491. https:\/\/doi.org\/10.1038\/s41467-023-42089-6.","journal-title":"Nat Commun"},{"key":"4582_CR61","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.ssresearch.2011.09.003","volume":"41","author":"AS Fullerton","year":"2012","unstructured":"Fullerton AS, Xu J. The proportional odds with partial proportionality constraints model for ordinal response variables. Soc Sci Res. 2012;41:182\u201398. https:\/\/doi.org\/10.1016\/j.ssresearch.2011.09.003.","journal-title":"Soc Sci Res"},{"key":"4582_CR62","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.spl.2003.07.017","volume":"65","author":"J-H Kim","year":"2003","unstructured":"Kim J-H. Assessing practical significance of the proportional odds assumption. Stat Probab Lett. 2003;65:233\u20139. https:\/\/doi.org\/10.1016\/j.spl.2003.07.017.","journal-title":"Stat Probab Lett"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-025-04582-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-025-04582-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-025-04582-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T20:37:26Z","timestamp":1767040646000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12916-025-04582-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,22]]},"references-count":62,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4582"],"URL":"https:\/\/doi.org\/10.1186\/s12916-025-04582-1","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,22]]},"assertion":[{"value":"23 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethical Committee of Zhejiang Cancer Hospital (approval no. IRB-2025\u20131764). All patients were granted written informed consent before participation in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"708"}}