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IJE Advance Access published online on August 31, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp280
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2009; all rights reserved.

Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer

Yuan-Chin Amy Lee1,{dagger}, Catherine Cohet1,{dagger}, Yu-Ching Yang1,2, Leslie Stayner3, Mia Hashibe1 and Kurt Straif1,*

1 International Agency for Research on Cancer, Lyon, France.
2 School of Public Health, University of California–Los Angeles, Los Angeles, CA, USA.
3 School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.

* Corresponding author. Carcinogen Identification and Evaluation Group, International Agency for Research on Cancer, 150 cours Albert Thomas, 69008 Lyon, France. E-mail: straif{at}iarc.fr


  Abstract

Background Whereas the International Agency for Research on Cancer (IARC) Monograph concluded that the evidence for the relationship between cigarette smoking and liver cancer is sufficient, the US Surgeon General's report summarized the data as suggestive but not sufficient.

Methods A meta-analysis of previous epidemiologic studies may help to clarify the potential association. We identified 38 cohort studies and 58 case–control studies in a systematic literature search for studies on liver cancer and cigarette smoking. The meta-relative risk (mRR) of liver cancer and dose–response trends were calculated. Tests for heterogeneity, publication bias assessment and influence analyses were performed.

Results Compared with never smokers, the adjusted mRR was 1.51 [95% confidence interval (CI) 1.37–1.67] for current smokers and 1.12 (95% CI 0.78–1.60) for former smokers. The increased liver cancer risk among current smokers appeared to be consistent in strata of different regions, study designs, study sample sizes and publication periods.

Conclusion The results of our meta-analysis show that tobacco smoking is associated with liver cancer development, which supports the conclusion by the IARC Monograph. This conclusion has an important public health message for areas with high smoking prevalence and high liver cancer incidence such as China.

Keywords Cigarette smoking, liver cancer, meta-analysis

{dagger} These authors contributed equally to this work.

Accepted 22 July 2009


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