Oncologic Network, Prevention and Research Institute (ISPRO), Florence.
Department of Environmental Health Science, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan.
Eur J Cancer Prev. 2023 Mar 1;32(2):171-183. doi: 10.1097/CEJ.0000000000000773. Epub 2022 Nov 10.
Cervical cancer (CC) is the fourth most frequent cancer worldwide. Cigarette smoking has been shown to influence CC risk in conjunction with human papillomavirus (HPV) infection. The aim of this study is to provide the most accurate and updated estimate of this association and its dose-response relationship.
Using an innovative approach for the identification of original publications, we conducted a systematic review and meta-analysis of studies published up to January 2021. Random effects models were used to provide pooled relative risks (RRs) of CC for smoking status. Dose-response relationships were evaluated using one-stage random effects models with linear or restricted cubic splines models.
We included 109 studies providing a pooled RR of invasive CC and preinvasive lesions, respectively, of 1.70 [95% confidence interval (CI), 1.53-1.88] and 2.11 (95% CI, 1.85-2.39) for current versus never smokers, and, respectively, 1.13 (95% CI, 1.02-1.24) and 1.29 (95% CI, 1.15-1.46) for former versus never smokers. Considering HPV does not alter the positive association or its magnitude. Risks of CC sharply increased with few cigarettes (for 10 cigarettes/day, RR = 1.72; 95% CI, 1.34-2.20 for invasive CC and RR = 2.13; 95% CI, 1.86-2.44 for precancerous lesions). The risk of CC increased with pack-years and smoking duration and decreased linearly with time since quitting, reaching that of never smokers about 15 years after quitting.
This comprehensive review and meta-analysis confirmed the association of smoking with CC, independently from HPV infection. Such association rose sharply with smoking intensity and decreased after smoking cessation.
宫颈癌（CC）是全球第四大常见癌症。已有研究表明，吸烟会影响 HPV 感染相关的 CC 发病风险。本研究旨在提供该关联及其剂量-反应关系的最准确和最新估计。
采用创新方法识别原始文献，我们对截至 2021 年 1 月发表的研究进行了系统评价和荟萃分析。采用随机效应模型提供吸烟状况与 CC 的汇总相对风险（RR）。使用一阶随机效应模型和线性或限制性立方样条模型评估剂量-反应关系。
我们纳入了 109 项研究，分别提供了浸润性 CC 和癌前病变的汇总 RR，当前吸烟者相对于从不吸烟者分别为 1.70（95%置信区间[CI]，1.53-1.88）和 2.11（95%CI，1.85-2.39），前吸烟者相对于从不吸烟者分别为 1.13（95%CI，1.02-1.24）和 1.29（95%CI，1.15-1.46）。此外，HPV 并未改变阳性关联或其程度。CC 的发病风险随着吸烟量的增加而急剧上升（对于每天 10 支烟，RR=1.72；95%CI，1.34-2.20 用于浸润性 CC，RR=2.13；95%CI，1.86-2.44 用于癌前病变）。CC 的发病风险随吸烟包年数和吸烟持续时间增加而线性增加，并随戒烟时间的延长而线性下降，大约在戒烟 15 年后达到从不吸烟者的水平。
本综述和荟萃分析证实了吸烟与 CC 的关联，该关联独立于 HPV 感染。这种关联随着吸烟强度的增加而急剧上升，戒烟后则下降。
