Interaction between cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer: a meta-analysis.
BACKGROUND
Chronic infection with hepatitis B (HBV) and C viruses (HCV) as well as cigarette smoking are established risk factors of hepatocellular carcinoma (HCC), but it is unclear whether an interaction exists between these factors in causing hepatocellular carcinogenesis. We conducted a meta-analysis to evaluate the interaction of HBV and HCV infection and cigarette smoking on the risk of HCC.


METHODS
We systematically searched the PUBMED and the China National Knowledge Infrastructure databases. A total of 16 eligible publications were identified. Cigarette smoking and chronic HBV and HCV infections were dichotomized into present or absent. Additive (S) and multiplicative interaction indexes (V) between smoking and each of the two infections and their 95% confidence intervals (95% CI) were calculated for each study and then combined in a meta-analysis.


RESULTS
We found a more than additive interaction between HBV infection and cigarette smoking (S=1.44; 95% CI, 1.00-2.06; nine studies) and a more than multiplicative interaction (V=1.60; 95% CI, 1.16-2.20; six studies) between HCV infection and cigarette smoking. No publication bias was detected.


CONCLUSIONS
Smoking seems to interact with both HBV and HCV in determining HCC risk. A pooled analysis of individual subject data, with appropriate adjustment with other risk factors, is warranted to confirm these results.


CONCLUSIONS
The results of this study imply the evidence of a synergistic effect between smoking and HBV or HCV infection on the risk of HCC. Thus, chronic carriers of HBV or HCV are recommended to avoid smoking.
Chuang
Shu-Chun
SC
IARC, International Prevention Research Institute, 95 cours Lafayette, 69006 Lyon, France.
Lee
Yuan-Chin Amy
YC
Hashibe
Mia
M
Dai
Min
M
Zheng
Tongzhang
T
Boffetta
Paolo
P
D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects*
Cancer Causes Control. 2003 Apr;14(3):241-50
12814203
J Clin Gastroenterol. 1995 Apr;20(3):220-4
7797831
Am J Trop Med Hyg. 2002 Apr;66(4):389-93
12164293
Br J Cancer. 2007 Apr 10;96(7):1127-34
17406349
Cancer. 2004 Sep 1;101(5):1009-17
15329910
Am J Epidemiol. 2003 Apr 15;157(8):674-82
12697571
Cancer Res. 1991 Oct 15;51(20):5621-5
1655259
BMJ. 1997 Sep 13;315(7109):629-34
9310563
Int J Cancer. 1984 Dec 15;34(6):775-9
6511124
CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
15761078
Drug Metab Dispos. 1997 Feb;25(2):154-62
9029045
Am J Epidemiol. 1997 Jun 1;145(11):1039-47
9169913
Control Clin Trials. 1986 Sep;7(3):177-88
3802833
Int J Cancer. 1987 Jan 15;39(1):45-9
3025110
Int J Epidemiol. 2009 Dec;38(6):1497-511
19720726
Hepatology. 1999 Feb;29(2):328-33
9918906
Ann Ist Super Sanita. 1987;24(2):217-23
3331068
Cancer Res. 1982 Dec;42(12):5246-8
6291750
J Natl Cancer Inst. 2004 Dec 15;96(24):1851-6
15601641
Am J Epidemiol. 2002 Feb 15;155(4):323-31
11836196
Ann Intern Med. 2004 Mar 16;140(6):465-79
15023713
Hepatology. 2007 Feb;45(2):507-39
17256718
Eur J Clin Invest. 2006 Jul;36(7):459-65
16796602
IARC Monogr Eval Carcinog Risks Hum. 2004;83:1-1438
15285078
Int J Cancer. 2003 Oct 20;107(1):106-12
12925964
Am J Epidemiol. 2000 Jan 15;151(2):131-9
10645815
Psychoneuroendocrinology. 1998 Feb;23(2):189-204
9621398
Cancer Epidemiol Biomarkers Prev. 2009 Jul;18(7):2054-60
19549812
Int J Cancer. 1991 Sep 30;49(3):377-80
1655659
Cancer Epidemiol Biomarkers Prev. 2006 Apr;15(4):683-9
16614109
Int J Cancer. 2006 Jun 15;118(12):3030-44
16404738
BMC Nephrol. 2005 Nov 22;6:13
16303055
Jpn J Cancer Res. 1988 Oct;79(10):1075-82
2848791
Int J Cancer. 2008 Oct 15;123(8):1883-91
18688864
Gastroenterology. 2008 Jul;135(1):111-21
18505690
Br J Cancer. 2006 Mar 13;94(5):737-9
16465190
Am J Physiol Heart Circ Physiol. 2007 Jan;292(1):H76-82
16920799
Arch Intern Med. 2002 Apr 8;162(7):811-5
11926856
Hepatology. 1991 Mar;13(3):398-406
1847891
Cancer Lett. 2009 Dec 1;286(1):9-14
19091458
Lancet Oncol. 2007 Sep;8(9):773-83
17714991
Stat Methods Med Res. 2008 Apr;17(2):171-89
17698938
Natl Cancer Inst Monogr. 1985 Dec;69:213-5
3834335
BMJ. 2006 May 6;332(7549):1064-9
16603565