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Cigarette smoking and the risk of nasopharyngeal carcinoma: a meta-analysis of epidemiological studies
  1. Mengjuan Long1,
  2. Zhenming Fu1,2,
  3. Ping Li1,
  4. Zhihua Nie1
  1. 1 Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
  2. 2 Cancer Center, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
  1. Correspondence to and Dr Zhenming Fu; davidfuzming{at}


Objective The role of cigarette smoking as an independent risk factor for patients with nasopharyngeal carcinoma (NPC) is controversial. We attempted to provide evidence of a reliable association between cigarette smoking and the risk of NPC.

Design Meta-analysis.

Data sources PubMed online and the Cochrane Library of relevant studies published up to February 2016.

Eligibility criteria All studies had to evaluate the relationship between NPC and cigarette smoking with never smokers as the reference group.

Outcomes The primary outcome was the adjusted OR, RR or HR of NPC patients comparing smoking with never-smoking; the second was the crude OR, RR or HR.

Results We identified 17 case–control studies and 4 cohort studies including 5960 NPC cases and 429 464 subjects. Compared with never smokers, current smokers and ever smokers had a 59% and a 56% greater risk of NPC, respectively. A dose–response relationship was identified in that the risk estimate rose by 15% (p<0.001) with every additional 10 pack-years of smoking, and risk increased with intensity of cigarette smoking (>30 cigarettes per day). Significantly increased risk was only found among male smokers (OR, 1.36; 95% CI 1.15 to 1.60), not among female smokers (OR, 1.58; 95% CI 0.99 to 2.53). Significantly increased risk also existed in the differentiated (OR, 2.34; 95% CI 1.77 to 3.09) and the undifferentiated type of NPC (OR, 1.15; 95% CI 0.90 to 1.46). Moreover, people who started smoking at younger age (<18 years) had a greater risk than those starting later for developing NPC (OR, 1.78; 95% CI 1.41 to 2.25).

Conclusions Cigarette smoking was associated with increased risk of NPC, especially for young smokers. However, we did not find statistical significant risks of NPC in women and in undifferentiated type, which might warrant further researches.

  • cigarette
  • smoker
  • nasopharyngeal carcinoma
  • risk factor
  • meta-analysis

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  • Contributors LONG and LI: did the literate research and selected the eligible articles separately; LI and NIE: extracted the whole data and assessed the quality of our selected articles; LONG: integrated and analyzed data, and wrote the manuscript. FU: designed and revised the manuscript. All authors: read and approved the final manuscript.

  • Funding This study was partially supported by grants 81472971 from the National Natural Science Foundation of China.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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