Schlecht N F, Franco E L, Pintos J, Negassa A, Kowalski L P, Oliveira B V, Curado M P
Department of Oncology, McGill University, Montreal, Canada.
Am J Epidemiol. 1999 Dec 1;150(11):1129-37. doi: 10.1093/oxfordjournals.aje.a009938.
The authors investigated the joint effects of tobacco and alcohol consumption on the risk of squamous cell carcinomas of the upper aero-digestive tract (UADT) using data from a hospital-based case-control study conducted in southern Brazil, 1986-1989. A total of 784 cases of cancers of the mouth, pharynx, and larynx and 1,578 non-cancer controls matched on age, sex, hospital catchment area, and period of admission were interviewed about their smoking and drinking habits and other characteristics. Using logistic regression, evidence was found for interaction between the cumulative exposures for smoking and alcohol on UADT cancer risk. The joint effects for pharyngeal cancers exceeded the levels expected under a multiplicative model for moderate smokers (p = 0.007). There was little statistical evidence, however, for interaction on cancers of the mouth (p = 0.28) or larynx (p = 0.95). Among never smokers, heavy drinkers had 9.2 times (95% confidence interval 1.7, 48.5) greater risk of cancers of mouth, pharynx, and supraglottis than never drinkers, with a dose-response trend (p = 0.013) with cumulative consumption. The authors conclude that the interaction occurring in the pharynx between smoking and alcohol on UADT cancers is not uniform, with varying effects depending on the level of smoking exposure. Alcohol may act as both a promoter for tobacco and as an independent risk factor.
作者利用1986 - 1989年在巴西南部开展的一项基于医院的病例对照研究数据，调查了烟草和酒精消费对上呼吸消化道（UADT）鳞状细胞癌风险的联合影响。共对784例口腔、咽和喉癌患者以及1578名年龄、性别、医院服务区域和入院时间相匹配的非癌症对照者进行了访谈，询问他们的吸烟和饮酒习惯以及其他特征。通过逻辑回归分析，发现吸烟和酒精的累积暴露量之间存在交互作用，影响UADT癌症风险。对于咽癌，联合效应超过了中度吸烟者乘法模型预期的水平（p = 0.007）。然而，对于口腔癌（p = 0.28）或喉癌（p = 0.95），几乎没有统计学证据表明存在交互作用。在从不吸烟者中，重度饮酒者患口腔、咽和声门上区癌症的风险是从不饮酒者的9.2倍（95%置信区间1.7, 48.5），且随着累积饮酒量呈现剂量反应趋势（p = 0.013）。作者得出结论，吸烟和酒精在咽癌方面对UADT癌症的交互作用并不一致，其影响因吸烟暴露水平而异。酒精可能既是烟草的促癌剂，也是独立的风险因素。
