Quadri Mir Faeq Ali, Tadakamadla Santosh Kumar, John Tenny
Faculty of Dentistry, Jazan University, Jazan, Saudi Arabia.
School of Dentistry and Oral Health, Griffith University, Southport, Australia.
Tob Induc Dis. 2019 Jul 18;17:56. doi: 10.18332/tid/110259. eCollection 2019.
Cancer of the oral cavity is regarded lethal with a fairly low mean 5-year survival rate. The current systematic review and meta-analysis is the first of its kind to examine, if the evidence from the Middle East and North African region indicates an association between oral cancer and tobacco; and evaluates the quality of the evidence that portrays this relationship.
A search for articles was carried out in October 2017 and then cross-checked at the end of June 2018 using Medline, Web of Science, CINAHL, and Cochrane databases. Retrieved articles were later subjected to eligibility criteria. The search was not limited to any particular research design adopted by the investigators. However, dissertations, theses and opinion-based reviews generated from the search were excluded during the screening of titles and abstracts. Quality of included studies was determined objectively (Newcastle Ottawa Scale) and subjectively. Revman (Version 5.3) was used for conducting the meta-analysis.
Six studies satisfied the selection criteria of the current review. The New Castle Ottawa evaluation scale suggested that the three cross-sectional studies and the three case-control studies included in the current review were of relatively low to moderate quality. All included studies explored the association of only one form of smokeless tobacco, i.e. shammah. Three case-control studies revealed a pooled estimate odds ratio of 38.74 (95% CI: 19.50-76.96), indicating that the odds for the occurrence of oral cancer among shammah users were nearly 39 times higher compared to the non-users.
Shammah is a potential risk factor for oral cancer; thus, it is necessary that public health practitioners design and implement effective strategies to prevent the abuse of shammah.
口腔癌被认为是致命的，其平均5年生存率相当低。当前的系统评价和荟萃分析首次检验了中东和北非地区的证据是否表明口腔癌与烟草之间存在关联，并评估了描述这种关系的证据质量。
2017年10月进行了文献检索，然后在2018年6月底使用Medline、科学网、护理学与健康领域数据库（CINAHL）和考克兰数据库进行了交叉核对。检索到的文章随后接受纳入标准筛选。检索不限于研究者采用的任何特定研究设计。然而，在标题和摘要筛选过程中排除了检索到的学位论文、毕业论文和基于观点的综述。采用客观（纽卡斯尔渥太华量表）和主观方法确定纳入研究的质量。使用Revman（5.3版）进行荟萃分析。
六项研究符合当前综述的选择标准。纽卡斯尔渥太华评估量表表明，当前综述纳入的三项横断面研究和三项病例对照研究质量相对较低至中等。所有纳入研究仅探讨了一种无烟烟草即沙马的关联。三项病例对照研究显示合并估计比值比为38.74（95%可信区间：19.50 - 76.96），表明沙马使用者患口腔癌的几率是非使用者的近39倍。
沙马是口腔癌的一个潜在危险因素；因此，公共卫生从业者有必要设计并实施有效的策略来预防沙马的滥用。
