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Review
. 2013 Aug 1;178(3):325-38.
doi: 10.1093/aje/kws479. Epub 2013 Jun 19.

Quantitative association of tobacco smoking with the risk of nasopharyngeal carcinoma: a comprehensive meta-analysis of studies conducted between 1979 and 2011

Wen-Qiong Xue  1 , Hai-De Qin, Hong-Lian Ruan, Yin Yao Shugart, Wei-Hua Jia
Affiliations
Review

Quantitative association of tobacco smoking with the risk of nasopharyngeal carcinoma: a comprehensive meta-analysis of studies conducted between 1979 and 2011

Wen-Qiong Xue et al. Am J Epidemiol. .

Abstract

Over the years, many studies have attempted to establish a link between tobacco smoking and an increased risk of nasopharyngeal carcinoma (NPC), but their results have been inconsistent. To clarify this link, we first conducted a comprehensive meta-analysis to integrate the findings of epidemiologic studies from the last half-century. The methodology used for this study followed the checklist proposed by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. Pooled risk estimates were generated using a random-effects model. Twenty-eight case-control studies and 4 cohort studies involving a total of 10,274 NPC cases and 415,266 comparison subjects were included. A substantial effect of smoking on the risk of NPC was identified in this study. The results showed that ever smokers had a 60% greater risk of developing the disease than never smokers (95% confidence interval: 1.38, 1.87); this was a robust dose-dependent association. More importantly, stronger associations were observed in low-risk populations and among persons with the predominant histological type of differentiated NPC than in high-risk populations and persons with an undifferentiated type; the odds ratios were 1.76 and 2.20, respectively, versus 1.29 and 1.27. In this comprehensive meta-analysis, well-established statistical evidence was provided about the role of tobacco smoking in the etiology of NPC.

Keywords: case-control studies; cohort studies; meta-analysis; nasopharyngeal carcinoma; odds ratio; tobacco smoking.

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Figures

Figure 1.
Figure 1.
Selection of studies included in a meta-analysis of the association between smoking and risk of nasopharyngeal carcinoma (NPC), 1979–2011. CI, confidence interval; CNKI, China National Knowledge Infrastructure.
Figure 2.
Figure 2.
Odds ratios (ORs) for nasopharyngeal carcinoma among ever smokers versus nonsmokers in individual studies and a meta-analysis, 1979–2011. Subtotals represent the pooled OR within each subcategory, based on a random-effects model. Heterogeneity for the subgroup analysis comparing the case-control studies with the cohort studies: P = 0.41, I2 = 0%. Bars, 95% confidence interval (CI).
Figure 3.
Figure 3.
Odds ratios (ORs) for nasopharyngeal carcinoma among former smokers (A) and current smokers (B) versus nonsmokers in individual studies and a meta-analysis, 1979–2011. Bars, 95% confidence interval (CI).
Figure 4.
Figure 4.
Odds ratios (ORs) for nasopharyngeal carcinoma among smokers who consumed <30 pack-years (A) and smokers who consumed ≥30 pack-years (B) in individual studies and a meta-analysis, 1979–2011. Bars, 95% confidence interval (CI).
Figure 5.
Figure 5.
Dose-response relationship between pack-years of smoking and risk of nasopharyngeal carcinoma in individual studies and a meta-analysis, 1979–2011. The dots represent the odds ratios (ORs) corresponding to the pack-years in each study. The sizes of the dots are inversely proportional to the logarithm of the variance of the ORs. The dashed line depicts the pooled risk estimate or nasopharyngeal carcinoma associated with each 1-pack-year increment of smoking (OR = 1.019, 95% confidence interval: 1.016, 1.021).
Figure 6.
Figure 6.
Funnel plot of the risk of nasopharyngeal carcinoma (log odds ratio (OR)) associated with ever having smoked in a meta-analysis, 1979–2011.
See this image and copyright information in PMC

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