Hashibe Mia, Brennan Paul, Benhamou Simone, Castellsague Xavier, Chen Chu, Curado Maria Paula, Dal Maso Luigino, Daudt Alexander W, Fabianova Eleonora, Fernandez Leticia, Wünsch-Filho Victor, Franceschi Silvia, Hayes Richard B, Herrero Rolando, Koifman Sergio, La Vecchia Carlo, Lazarus Philip, Levi Fabio, Mates Dana, Matos Elena, Menezes Ana, Muscat Joshua, Eluf-Neto Jose, Olshan Andrew F, Rudnai Peter, Schwartz Stephen M, Smith Elaine, Sturgis Erich M, Szeszenia-Dabrowska Neonilia, Talamini Renato, Wei Qingyi, Winn Deborah M, Zaridze David, Zatonski Witold, Zhang Zuo-Feng, Berthiller Julien, Boffetta Paolo
Gene-Environment Epidemiology Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, France.
J Natl Cancer Inst. 2007 May 16;99(10):777-89. doi: 10.1093/jnci/djk179.
At least 75% of head and neck cancers are attributable to a combination of cigarette smoking and alcohol drinking. A precise understanding of the independent association of each of these factors in the absence of the other with the risk of head and neck cancer is needed to elucidate mechanisms of head and neck carcinogenesis and to assess the efficacy of interventions aimed at controlling either risk factor.
We examined the extent to which head and neck cancer is associated with cigarette smoking among never drinkers and with alcohol drinking among never users of tobacco. We pooled individual-level data from 15 case-control studies that included 10,244 head and neck cancer case subjects and 15,227 control subjects, of whom 1072 case subjects and 5775 control subjects were never users of tobacco and 1598 case subjects and 4051 control subjects were never drinkers of alcohol. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. All statistical tests were two-sided.
Among never drinkers, cigarette smoking was associated with an increased risk of head and neck cancer (OR for ever versus never smoking = 2.13, 95% CI = 1.52 to 2.98), and there were clear dose-response relationships for the frequency, duration, and number of pack-years of cigarette smoking. Approximately 24% (95% CI = 16% to 31%) of head and neck cancer cases among nondrinkers in this study would have been prevented if these individuals had not smoked cigarettes. Among never users of tobacco, alcohol consumption was associated with an increased risk of head and neck cancer only when alcohol was consumed at high frequency (OR for three or more drinks per day versus never drinking = 2.04, 95% CI = 1.29 to 3.21). The association with high-frequency alcohol intake was limited to cancers of the oropharynx/hypopharynx and larynx.
Our results represent the most precise estimates available of the independent association of each of the two main risk factors of head and neck cancer, and they exemplify the strengths of large-scale consortia in cancer epidemiology.
至少75%的头颈癌可归因于吸烟与饮酒的共同作用。为了阐明头颈癌发生的机制并评估旨在控制任一风险因素的干预措施的效果，需要精确了解在不存在另一个因素的情况下，这些因素各自与头颈癌风险的独立关联。
我们研究了头颈癌在从不饮酒者中与吸烟的关联程度，以及在从不吸烟的人群中与饮酒的关联程度。我们汇总了15项病例对照研究的个体水平数据，这些研究包括10244名头颈癌病例受试者和15227名对照受试者，其中1072例病例受试者和5775名对照受试者从不吸烟，1598例病例受试者和4051名对照受试者从不饮酒。使用无条件逻辑回归模型估计比值比（OR）和95%置信区间（CI）。所有统计检验均为双侧检验。
在从不饮酒者中，吸烟与头颈癌风险增加相关（曾经吸烟与从不吸烟的OR = 2.13，95%CI = 1.52至2.98），并且吸烟频率、持续时间和吸烟包年数存在明显的剂量反应关系。如果本研究中的不饮酒者不吸烟，约24%（95%CI = 16%至31%）的头颈癌病例本可避免。在从不吸烟的人群中，仅当高频饮酒时，饮酒才与头颈癌风险增加相关（每天饮用三杯或更多杯与从不饮酒的OR = 2.04，95%CI = 1.29至3.21）。与高频饮酒的关联仅限于口咽/下咽癌和喉癌。
我们的结果代表了头颈癌两个主要风险因素各自独立关联的最精确估计，并且例证了癌症流行病学中大规模联合研究的优势。
