Maserejian Nancy Nairi, Joshipura Kaumudi J, Rosner Bernard A, Giovannucci Edward, Zavras Athanasios I
Department of Epidemiology, Harvard School of Dental Medicine, Boston, USA.
Cancer Epidemiol Biomarkers Prev. 2006 Apr;15(4):774-81. doi: 10.1158/1055-9965.EPI-05-0842.
Recent case-control studies indicate that alcohol increases the risk of oral premalignant lesions (OPL) among tobacco users, but the independent association between alcohol and OPL remains unclear. We prospectively evaluated the association between alcohol consumption and the incidence of OPL. Participants were 41,458 men in the Health Professionals Follow-up Study. Alcohol consumption was assessed every 4 years using validated food frequency questionnaires. We confirmed clinically or histopathologically diagnosed OPL events occurring between 1986 and 2002 by medical record review (193 cases). Multivariate-adjusted relative risks of OPL were calculated from Cox proportional hazards models. With detailed control for tobacco and other variables, multivariate relative risks (95% confidence intervals) were 1.7 (0.9-3.2) for drinkers of 0.1 to 14.9 g/d, 2.9 (1.5-5.6) for 15 to 29.9 g/d, and 2.5 (1.3-5.1) for > or =30 g/d, compared with nondrinkers. Approximately one additional drink per day (12.5 g) was associated with a 22% increase in risk (P < 0.001). The associations did not vary by beverage type, frequency, or consumption with meals. Results were similar when restricted to cases of oral epithelial dysplasia. Alcohol increased OPL risk in never-users of tobacco as well as in past or current users. An interaction between alcohol and tobacco was apparent by their more-than-additive joint effects. Alcohol is an independent risk factor for OPL, regardless of beverage type or drinking pattern. Recommendations to reduce alcohol intake have the potential to reduce incidence of OPL in nonsmokers and smokers alike.
近期的病例对照研究表明，酒精会增加烟草使用者患口腔癌前病变（OPL）的风险，但酒精与OPL之间的独立关联仍不明确。我们前瞻性地评估了饮酒与OPL发病率之间的关联。参与者为健康专业人员随访研究中的41458名男性。每4年使用经过验证的食物频率问卷评估饮酒情况。我们通过病历审查确认了1986年至2002年间临床或组织病理学诊断的OPL事件（193例）。从Cox比例风险模型计算出OPL的多变量调整相对风险。在对烟草和其他变量进行详细控制后，与不饮酒者相比，每天饮酒0.1至14.9克的饮酒者的多变量相对风险（95%置信区间）为1.7（0.9 - 3.2），15至29.9克的为[2.9（1.5 - 5.6）]，≥30克的为2.5（1.3 - 5.1）。每天额外多喝一杯（12.5克）与风险增加22%相关（P < 0.001）。这些关联不因饮料类型、频率或是否与餐同服而有所不同。当仅限于口腔上皮发育异常的病例时，结果相似。酒精会增加从不吸烟以及曾经或现在吸烟人群患OPL的风险。酒精和烟草之间存在明显的超相加联合效应。无论饮料类型或饮酒模式如何，酒精都是OPL的独立危险因素。减少酒精摄入量的建议有可能降低非吸烟者和吸烟者中OPL的发病率。
