title: Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies.
abstract: Tobacco smoking was one of the risk factors for upper aerodigestive tract cancer, but exclusive quantification of the impact of cigarette smoking on laryngeal cancer had not been investigated. A meta-analysis of researches that had reported quantitative estimates of cigarette smoking and risk of laryngeal cancer by March 2016 was performed. Pooled estimates of relative risks and their 95% confidence intervals were obtained and summarized. Sensitivity analysis and subgroup analysis were implemented to find out sources of research heterogeneity and the effect of potential confounders. Publication bias was investigated and corrected if found to be present through Egger's and Begg's test, and trim and fill algorithm. Thirty researches based on a total of 14,292 cases from three cohort and fifteen case-control studies were included and pooled estimate for the correlation between cigarette smoking and the risk of laryngeal cancer was 7.01 (95% confidence interval 5.56-8.85), with moderate heterogeneity across the researches (I2= 56.7%, p = 0.002). The RRs were 5.04 (95% CI 3.09-8.22) for cohort studies (p = 0.121), 7.59 (95% CI 5.86-9.82) for case-control studies (p = 0.005). The risk kept elevated within the first fifteen years of quitting smoking(RR 3.62, 95% CI 1.88-7.00) but dropped in the 16 years and more after smoking cessation(RR 1.88, 95% CI 1.16-3.05). Individuals who smoked with 40 or more pack-years had nine times the risk of laryngeal cancer(RR 9.14; 95% CI 6.24-13.39). Subjects who smoked 30 or more cigarettes a day had sevenfolds the risk of laryngeal cancer (RR 7.02; 95% CI 4.47-11.02) and who smoked 40 or more years had five times the risk versus never smokers (RR 5.76; 95% CI 3.69-8.99). Evidence of publication bias was not detected for the correlation between current cigarette smoking and risk of laryngeal cancer (p = 0.225 with Begg's test, p = 0.317 with Egger's test). The results demonstrated strong correlation referring to dose-response and time-response between cigarette smoking and risk of laryngeal cancer for both men and women. The probability of developing laryngeal cancer was decreased by quitting smoking, particularly among former cigarette smokers who had stopped smoking for 15 or more years. The subgroup analysis demonstrated that study type influenced the RRs estimates of the studies.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery II, Renmin Hospital of Wuhan University, Jie-Fang Road 238, Wuhan, 430060, Hubei, People's Republic of China. otolaryngologyzjj@whu.edu.cn.|Otolaryngology-Head and Neck Surgery Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China. otolaryngologyzjj@whu.edu.cn.
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Zuo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery II, Renmin Hospital of Wuhan University, Jie-Fang Road 238, Wuhan, 430060, Hubei, People's Republic of China. taozezhang@hotmail.com.|Otolaryngology-Head and Neck Surgery Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China. taozezhang@hotmail.com.
authors.forename: Ze-Zhang
authors.identifier: http://orcid.org/0000-0001-9383-7480
authors.initials: ZZ
authors.lastname: Tao
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery II, Renmin Hospital of Wuhan University, Jie-Fang Road 238, Wuhan, 430060, Hubei, People's Republic of China.|Otolaryngology-Head and Neck Surgery Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery II, Renmin Hospital of Wuhan University, Jie-Fang Road 238, Wuhan, 430060, Hubei, People's Republic of China.|Otolaryngology-Head and Neck Surgery Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Zhang-Wei
authors.initials: ZW
authors.lastname: Hu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery II, Renmin Hospital of Wuhan University, Jie-Fang Road 238, Wuhan, 430060, Hubei, People's Republic of China.|Otolaryngology-Head and Neck Surgery Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: Ye-Xing
authors.initials: YX
authors.lastname: Xu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery II, Renmin Hospital of Wuhan University, Jie-Fang Road 238, Wuhan, 430060, Hubei, People's Republic of China.|Otolaryngology-Head and Neck Surgery Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, People's Republic of China.
authors.forename: An-Yuan
authors.initials: AY
authors.lastname: Zheng
authors.affiliation: The State Key Laboratory of Virology, Department of Epidemiology, School of Public Health, Wuhan University, Wuhan, Hubei, 430071, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Guo
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
keywords: Cancer; Cigarette; Larynx; Meta-analysis; Smoking