SynthesisJournal of the National Cancer Institute2019
Physical Activity and the Risk of Liver Cancer: A Systematic Review and Meta-Analysis of Prospective Studies and a Bias Analysis.
Synthesis in Journal of the National Cancer Institute, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 30 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 54 citations in OpenAlex.
- Methods to Address Confounding and Other Biases in Meta-Analyses: Review and Recommendations.Annual review of public health · 2022Pooled it
- Associations between Physical Activity and Liver Cancer Risks and Mortality: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2020Pooled it
- Prophylactic Effects of Dietary Patterns and Indexes, Nutrition and Lifestyle on Hepatocellular Carcinoma.Annals of surgical oncology · 2026Review
- The working population's health literacy and changes in physical activity over one year.BMC public health · 2025Article
- Lifestyle factors in hepatocellular carcinoma: From pathogenesis to prognosis.World journal of clinical oncology · 2025Review
- Current and emerging strategies for the prevention of hepatocellular carcinoma.Nature reviews. Gastroenterology & hepatology · 2025Review
- Epidemiology, pathophysiology and clinical aspects of Hepatocellular Carcinoma in MAFLD patients.Hepatology international · 2024Review
- Association of physical activity, including amount and maintenance, with the risk of HCC among patients with type 2 diabetes.JHEP reports : innovation in hepatology · 2024Article
- The Growing Landscape of NAFLD-Associated Hepatocellular Carcinoma and Its Impact in Surveillance.GE Portuguese journal of gastroenterology · 2024Review
- A survey questionnaire evaluating physical activity patterns and determinants in patients with chronic liver disease.Journal of gastroenterology · 2024Article
- A review of MASLD-related hepatocellular carcinoma: progress in pathogenesis, early detection, and therapeutic interventions.Frontiers in medicine · 2024Review
- Adherence to an antioxidant diet and lifestyle is associated with reduced risk of cardiovascular disease and mortality among adults with nonalcoholic fatty liver disease: evidence from NHANES 1999-2018.Frontiers in nutrition · 2024Article
- Sensitivity analysis for the interactive effects of internal bias and publication bias in meta-analyses.Research synthesis methods · 2024Article
- Types of Physical Activity in Nonalcoholic Fatty Liver Disease and All-Cause and Cardiovascular Mortality.Journal of clinical medicine · 2023Article
- Preventive strategy for nonalcoholic fatty liver disease-related hepatocellular carcinoma.Clinical and molecular hepatology · 2023Review
- Screening and interventions to prevent nonalcoholic fatty liver disease/nonalcoholic steatohepatitis-associated hepatocellular carcinoma.World journal of gastroenterology · 2023Review
- Reducing Liver Cancer Risk through Dietary Change: Positive Results from a Community-Based Educational Initiative in Three Racial/Ethnic Groups.Nutrients · 2022Article
- The role of lifestyle factors on comorbidity of chronic liver disease and cardiometabolic disease in Chinese population: A prospective cohort study.The Lancet regional health. Western Pacific · 2022Article
- Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: Current Progresses and Challenges.Journal of clinical and translational hepatology · 2022Review
- Review
Corrections and comments
- Commented on by
- Commented on by
- Erratum issuedCorrigendum.2020
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPhysical inactivity is an established risk factor for several cancers of the digestive system and female reproductive organs, but the evidence for liver cancers is less conclusive.
methodsThe aim of this study was to synthesize prospective observational studies on the association of physical activity and liver cancer risk by means of a systematic review and meta-analysis. We searched Medline, Embase, and Scopus from inception to January 2019 for prospective studies investigating the association of physical activity and liver cancer risk. We calculated mean hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. We quantified the extent to which an unmeasured confounder or an unaccounted selection variable could shift the mean hazard ratio to the null.
resultsFourteen prospective studies, including 6,440 liver cancers, were included in the systematic review and meta-analysis. The mean hazard ratio for high compared with low physical activity was 0.75 (95% CI = 0.63 to 0.89; 95% prediction interval = 0.52 to 1.07; I² = 64.2%). We estimated that 67.6% (95% CI = 56.6% to 78.5%) of all true effect estimates would have a hazard ratio less than 0.8. Bias analysis suggested than an unobserved confounder would have to be associated with a 1.99-fold increase in the risk of physical activity or liver cancer to explain away the observed mean hazard ratio. An unaccounted for selection variable would have to be related to exposure and endpoint with a relative risk of 1.58 to explain away the mean hazard ratio.
conclusionsPhysical activity is inversely related to the risk of liver cancer. Further studies with objectively measured physical activity and quasi-experimental designs addressing confounding are needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.