Evaluating the effect of metabolic traits on oral and oropharyngeal cancer risk using Mendelian randomization
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eLife assessment
This is an important study linking metabolic traits and head and neck cancer risk using Mendelian randomisation. The findings, well supported by the data, were inconclusive. This work will be of interest to researchers working in head and neck cancer.
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Abstract
A recent World Health Organization report states that at least 40% of all cancer cases may be preventable, with smoking, alcohol consumption, and obesity identified as three of the most important modifiable lifestyle factors. Given the significant decline in smoking rates, particularly within developed countries, other potentially modifiable risk factors for head and neck cancer warrant investigation. Obesity and related metabolic disorders such as type 2 diabetes (T2D) and hypertension have been associated with head and neck cancer risk in multiple observational studies. However, adiposity has also been correlated with smoking, with bias, confounding or reverse causality possibly explaining these findings. To overcome the challenges of observational studies, we conducted two-sample Mendelian randomization (inverse variance weighted [IVW] method) using genetic variants which were robustly associated with adiposity, glycaemic and blood pressure traits in genome-wide association studies (GWAS). Outcome data were taken from the largest available GWAS of 6034 oral and oropharyngeal cases, with 6585 controls. We found limited evidence of a causal effect of genetically proxied body mass index (BMI; OR IVW = 0.89, 95% CI 0.72–1.09, p = 0.26 per 1 standard deviation in BMI [4.81kg/m 2 ]) on oral and oropharyngeal cancer risk. Similarly, there was limited evidence for related traits including T2D and hypertension. Small effects cannot be excluded given the lack of power to detect them in currently available GWAS.
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eLife assessment
This is an important study linking metabolic traits and head and neck cancer risk using Mendelian randomisation. The findings, well supported by the data, were inconclusive. This work will be of interest to researchers working in head and neck cancer.
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Reviewer #1 (Public Review):
Gormley et al. conduct a comprehensive Mendelian randomisation (MR) analysis to study the causal effect of obesity and metabolic disorder on oral and oropharyngeal cancer. This work follows on from observational studies that found evidence of associations between these variables and continued on from a previous MR study that focused on the effect of circulating lipid traits on these cancer outcomes. In this study, the authors found limited evidence for an effect of obesity-related traits on either cancer type, contradicting the previous observational studies and thus implying that the latter may have been affected by confounding. Sensitivity analyses that adjusted for potential pleiotropy and outlying instrumental variants agreed with the main study findings. Risk factors including smoking, risk-taking (a …
Reviewer #1 (Public Review):
Gormley et al. conduct a comprehensive Mendelian randomisation (MR) analysis to study the causal effect of obesity and metabolic disorder on oral and oropharyngeal cancer. This work follows on from observational studies that found evidence of associations between these variables and continued on from a previous MR study that focused on the effect of circulating lipid traits on these cancer outcomes. In this study, the authors found limited evidence for an effect of obesity-related traits on either cancer type, contradicting the previous observational studies and thus implying that the latter may have been affected by confounding. Sensitivity analyses that adjusted for potential pleiotropy and outlying instrumental variants agreed with the main study findings. Risk factors including smoking, risk-taking (a proxy for sexual behavior), and alcohol consumption were also stratified for, and only evidence was found for smoking as a mediator of the observed effect.
Strengths:
Strengths of this study include the thorough MR analysis conducted, with all required sensitivity analyses and checks conducted and summarised appropriately, including the use of recent MR methods such as SIMEX where required. For the disease outcomes, oral and oropharyngeal cancer, the authors used summary statistics from the single largest trans-ethnic published meta-analysis GWAS available. Known risk factors were stratified for in sensitivity analyses to follow up any results of interest. Where measures of risk factors were not directly available (e.g. sexual behaviour), genetically-correlated proxy measures were used.Weaknesses:
While this study has several strengths, there are also a number of limitations present, many of which the authors outline in the paper. In particular, the sample size of the outcome GWAS used was rather small which may hinder the power. Also, some of the cancer subtypes of interest that had previously been investigated in observational studies were not available as GWAS, and so could not be included in this study. The authors only used European or trans-ancestry GWAS, as these are the only ancestries presently available, but a future investigation into other ethnicities is warranted. They also used risk-taking (self-defined via questionnaire) as a proxy for sexual behaviour, which despite having a strong genetic correlation, may not be the best substitute. -
Reviewer #2 (Public Review):
The authors used Mendelian randomisation to study the relationships between metabolic traits and oral/oropharyngeal/head and neck cancers. This study was conducted as the relationships between these traits and cancers are unclear based on observational data. Evidence for relationships between these traits and cancers is inconclusive, which is a relevant finding in the context of previous observational data.
Strengths include using large studies to develop the instrumental variables used in MR and examining multiple metabolic traits. Weaknesses include relatively low power to detect associations and a lack of discussion around any possible pleiotropy of SNPs associated with any of the metabolic traits. Based on these strengths and weaknesses, it is unclear whether the authors achieved their goal and whether …
Reviewer #2 (Public Review):
The authors used Mendelian randomisation to study the relationships between metabolic traits and oral/oropharyngeal/head and neck cancers. This study was conducted as the relationships between these traits and cancers are unclear based on observational data. Evidence for relationships between these traits and cancers is inconclusive, which is a relevant finding in the context of previous observational data.
Strengths include using large studies to develop the instrumental variables used in MR and examining multiple metabolic traits. Weaknesses include relatively low power to detect associations and a lack of discussion around any possible pleiotropy of SNPs associated with any of the metabolic traits. Based on these strengths and weaknesses, it is unclear whether the authors achieved their goal and whether the results support their conclusions.
This work is relevant to researchers interested in oral cancers and their etiology. Several issues would need to be addressed to make the evidence more reliable.
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