Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy.
Cancer Epidemiol. 2012 Feb;36(1):e1-6. doi: 10.1016/j.canep.2011.09.009. Epub 2011 Oct 20.
Alcohol drinking is an oral cancer (OC) risk factor; tobacco smoking (TS) and betel quid chewing (BQC) are oral carcinogens and effect modifiers of drinking. Although the assessment of the independent effect of drinking on OC must necessarily account for effect modifiers, no observational study has included interaction terms between drinking, TS, BQC in regression analyses. In order to assess the independent association between drinking and OC, this pooled analysis focused on subjects who were not exposed to such effect modifiers.
Case-control studies on OC, which discriminated non TS/non BQC drinkers from multiexposed drinkers were searched. Exposed subjects (≥1 drink daily, ≥10 years) were compared to unexposed subjects (non/occasional drinkers). Unadjusted odds ratios (ORs) were extracted/calculated. Pooled ORs were assessed with the random-effect method, which assumed high between-study heterogeneity (assessed with Cochran's Q). Robustness of estimates was investigated through use of adjusted ORs, correction for publication bias, sensitivity analysis to inclusion criteria. The drinking-TS interaction was assessed with the Interaction Contrast Ratio (ICR) and the Attributable Proportion due to Interaction (AP).
Sixteen studies were used, with substantially high heterogeneity. The pooled OR was 0.787 (95CI, 0.677-0.914). Use of adjusted ORs, correction for publication bias, sensitivity analysis corroborated these results. ICR and AP were 2.444 and 54.6%.
Consistent with stratified analyses reporting non significant/negative associations between alcohol drinking and OC in non multiexposed subjects, an OC preventive activity of drinking is inferable. However, given the high prevalence and the oral carcinogenicity of concomitant drinking and smoking, drinking control policies remain essential.
饮酒是口腔癌（OC）的一个风险因素；吸烟（TS）和咀嚼槟榔（BQC）是口腔致癌物，也是饮酒的效应修饰物。尽管评估饮酒对 OC 的独立影响必然要考虑到效应修饰物，但没有观察性研究在回归分析中包括饮酒、TS、BQC 之间的交互项。为了评估饮酒与 OC 之间的独立关联，本荟萃分析重点关注未接触这些效应修饰物的受试者。
对 OC 的病例对照研究进行了搜索，这些研究区分了非 TS/非 BQC 饮酒者和多暴露饮酒者。将暴露组（每天≥1 杯，≥10 年）与未暴露组（非/偶尔饮酒者）进行比较。提取/计算未调整的比值比（ORs）。采用随机效应法评估汇总 OR，假设存在高度异质性（采用 Cochran's Q 评估）。通过使用调整后的 OR、校正发表偏倚、对纳入标准的敏感性分析来评估估计值的稳健性。使用交互对比比（ICR）和交互归因比例（AP）评估饮酒与 TS 的相互作用。
使用了 16 项研究，异质性很高。汇总 OR 为 0.787（95%CI，0.677-0.914）。使用调整后的 OR、校正发表偏倚、敏感性分析都证实了这些结果。ICR 和 AP 分别为 2.444 和 54.6%。
与报告非多暴露受试者中饮酒与 OC 之间无显著/负相关的分层分析一致，可以推断饮酒具有预防 OC 的作用。然而，鉴于同时饮酒和吸烟的高患病率和口腔致癌性，饮酒控制政策仍然至关重要。
