Ansary-Moghaddam Alireza, Huxley Rachel R, Lam Tai Hing, Woodward Mark
George Institute for International Health, New South Wales, Australia.
Mt Sinai J Med. 2009 Aug;76(4):392-403. doi: 10.1002/msj.20125.
Smoking and alcohol are major causal factors for upper aerodigestive tract cancer, but reliable quantification of the combined impact of smoking and alcohol on this cancer and its major subtypes has not been performed.
A meta-analysis of studies that had published quantitative estimates of smoking and upper aerodigestive tract cancer by January 2007 was performed. Pooled estimates of relative risks were obtained. Publication bias was investigated through funnel plots and corrected if found to be present.
Overall, 85 studies with information on 53,940 individuals with upper aerodigestive tract cancer were included. The pooled estimate for the association between smoking and the risk of this cancer was 3.47 (95% confidence interval, 3.06-3.92). The risk remained elevated for a decade after smoking cessation but declined thereafter. Individuals who both smoked and consumed alcohol had double the risk of upper aerodigestive tract cancer in comparison with those who only smoked: the relative risk was 6.93 (95% confidence interval, 4.99-9.62) for the former and 2.56 (95% confidence interval, 2.20-2.97) for the latter (P < 0.001).
Public health interventions that simultaneously discourage smoking and heavy drinking would have greater benefits than would be expected from those that target only one of these risk factors.
吸烟和饮酒是上消化道癌症的主要致病因素，但尚未对吸烟和饮酒对上消化道癌症及其主要亚型的综合影响进行可靠量化。
对截至2007年1月已发表吸烟与上消化道癌症定量估计的研究进行荟萃分析。获得相对风险的合并估计值。通过漏斗图研究发表偏倚，若发现存在则进行校正。
总体而言，纳入了85项研究，涉及53940例上消化道癌症患者。吸烟与该癌症风险之间关联的合并估计值为3.47（95%置信区间，3.06 - 3.92）。戒烟后十年风险仍居高不下，但此后有所下降。既吸烟又饮酒的个体患上消化道癌症的风险是仅吸烟个体的两倍：前者的相对风险为6.93（95%置信区间，4.99 - 9.62），后者为2.56（95%置信区间，2.20 - 2.97）（P < 0.001）。
同时劝阻吸烟和重度饮酒的公共卫生干预措施比仅针对其中一个风险因素的干预措施具有更大的益处。
