title: Alcohol and liver cancer: a systematic review and meta-analysis of prospective studies.
abstract: Despite several studies support a positive association between heavy alcohol consumption and liver cancer risk, a consistent dose-risk relationship has not yet been established. We carried out a systematic review and a meta-analysis of the association between alcohol intake and liver cancer occurrence, following the Meta-analysis Of Observational Studies in Epidemiology guidelines. We searched for cohort and nested case-control studies on the general population published before April 2013, using PubMed and EMBASE. Summary meta-analytic relative risks (RRs) were estimated using random-effect models. We included 16 articles (19 cohorts) for a total of 4445 incident cases and 5550 deaths from liver cancer. Compared with non-drinking, the pooled RRs were 0.91 (95% confidence interval, CI, 0.81-1.02) for moderate drinking (< 3 drinks per day) and 1.16 (95% CI, 1.01-1.34) for heavy drinking (≥ 3 drinks per day), with significant heterogeneity among studies. The dose-risk curve suggested a linear relationship with increasing alcohol intake in drinkers, with estimated excess risk of 46% for 50 g of ethanol per day and 66% for 100 g per day. This systematic review suggests a moderate detrimental role of consumption of 3 or more alcoholic drinks per day on liver cancer, and a lack of association with moderate drinking. Our results have to be taken with due caution on account of the possible limitations of the original studies included in the meta-analysis.
authors.affiliation: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan.
authors.forename: F
authors.initials: F
authors.lastname: Turati
authors.affiliation: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan.
authors.forename: C
authors.initials: C
authors.lastname: Galeone
authors.affiliation: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Monza.
authors.forename: M
authors.initials: M
authors.lastname: Rota
authors.affiliation: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan claudio.pelucchi@marionegri.it.
authors.forename: C
authors.initials: C
authors.lastname: Pelucchi
authors.affiliation: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan.
authors.forename: E
authors.initials: E
authors.lastname: Negri
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Bagnardi
authors.affiliation: Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan.
authors.forename: G
authors.initials: G
authors.lastname: Corrao
authors.affiliation: The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, USA.
authors.forename: P
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: La Vecchia
mesh_terms: D000428:Alcohol Drinking / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
keywords: alcohol; epidemiology; liver cancer; meta-analysis; risk factors; systematic review