The magnitude of tobacco smoking-betel quid chewing-alcohol drinking interaction effect on oral cancer in South-East Asia. A meta-analysis of observational studies.
The magnitude of tobacco smoking-betel quid chewing-alcohol drinking interaction effect on oral cancer in South-East Asia. A meta-analysis of observational studies.
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DOI：
10.1371/journal.pone.0078999
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Scully C
中科院分区：
文献类型：
--
作者：
Petti S;Masood M;Scully C
吸烟、咀嚼槟榔和饮酒是口腔癌的危险因素。观察性研究一致报告，吸烟、饮酒、咀嚼暴露的受试者患口腔癌的风险特别高。然而，他们都没有评估这种风险的比例可归因于三个单独的风险因素以及吸烟-饮酒-咀嚼相互作用。本研究旨在评估吸烟、饮酒、咀嚼相互作用对口腔癌的影响程度。对东南亚观察性研究进行了荟萃分析，报告了针对吸烟、饮酒、咀嚼暴露进行分层的口腔癌比值比 (OR)。对合并的 OR 进行估计并控制质量、异质性、发表偏倚和纳入标准。吸烟-饮酒-咀嚼相互作用效应是通过相互作用引起的相对超额风险（RERI，相对于吸烟、饮酒和咀嚼这三个个体风险相加的预期风险而言的吸烟-饮酒-咀嚼暴露个体的超额风险）来估计的。纳入的十四项研究的研究间异质性较低。吸烟、饮酒、咀嚼、吸烟-饮酒-咀嚼的汇总 OR 分别为 3.6（95% 置信区间 -95% CI，1.9-7.0）、2.2（95% CI，1.6-3.0）、7.9（95% CI，6.7-9.3）、40.1（95% CI，35.1-45.8）。汇总 RERI 为 28.4（95% CI，22.9-33.7）。在吸烟-饮酒-咀嚼受试者中，个体效应占风险的6.7%（吸烟）、3.1%（饮酒）、17.7%（咀嚼），而交互效应占剩余的72.6%。这些数据表明，东南亚每年有 44,200 例口腔癌病例发生在吸烟-饮酒-咀嚼暴露对象中，其中 40,400 例完全与相互作用效应相关。有效的口腔癌控制政策必须将同时吸烟、饮酒、咀嚼槟榔视为一种独特的不健康生活方式。
Tobacco smoking, betel quid chewing and alcohol drinking are oral cancer risk factors. Observational studies unanimously report that oral cancer risk in smoking-drinking-chewing exposed subjects is exceptionally high. However, none of them assessed the fractions of this risk attributable to the three individual risk factors and to the smoking-drinking-chewing interaction. The present study sought to assess the magnitude of the smoking-drinking-chewing interaction effect on oral cancer. A meta-analysis of observational South-East Asian studies which reported oral cancer odds ratios (ORs) stratified for smoking-drinking-chewing exposures was performed. The pooled ORs were estimated and controlled for quality, heterogeneity, publication bias and inclusion criteria. The smoking-drinking-chewing interaction effect was estimated through the pooled Relative Excess Risk due to Interaction (RERI, excess risk in smoking-drinking-chewing exposed individuals with respect to the risk expected from the addition of the three individual risks of smoking, drinking and chewing). Fourteen studies were included with low between-study heterogeneity. The pooled ORs for smoking, drinking, chewing, smoking-drinking-chewing, respectively were 3.6 (95% confidence interval −95% CI, 1.9–7.0), 2.2 (95% CI, 1.6–3.0), 7.9 (95% CI, 6.7–9.3), 40.1 (95% CI, 35.1–45.8). The pooled RERI was 28.4 (95% CI, 22.9–33.7). Among smoking-drinking-chewing subjects, the individual effects accounted for 6.7% (smoking), 3.1% (drinking), 17.7% (chewing) of the risk, while the interaction effect accounted for the remaining 72.6%. These data suggest that 44,200 oral cancer cases in South-East Asia annually occur among smoking-drinking-chewing exposed subjects and 40,400 of these are exclusively associated with the interaction effect. Effective oral cancer control policies must consider concurrent tobacco smoking, alcohol drinking, betel quid chewing usages as a unique unhealthy lifestyle.
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