Alcohol consumption and liver cancer risk: a meta-analysis
A partir d'une revue systématique de la littérature publiée jusqu'en 2014 (112 études), cette méta-analyse fait le point sur l'association entre une consommation d'alcool, en fonction de la quantité et de la fréquence, et le risque de cancer du foie
Purpose : Alcohol is a confirmed risk factor of liver cancer. Yet, its dose–response function and synergistic effects with other risk factors remain unclear. Methods : We performed a meta-analysis on publications up to May 2014. A total of 112 publications were identified. The meta-relative risk (mRR) and the dose–response trend were calculated. Tests for heterogeneity, publication bias, and sensitivity analyses were performed. The synergy index (SI) was recorded or calculated, whenever possible. Results : Compared to individuals who never drank or drank at very low frequencies, the mRR for ever drinkers was 1.29 (95 % confidence interval, CI 1.16–1.42) and 1.46 (95 % CI 1.27–1.65) for case–control studies, and 1.07 (95 % CI 0.87–1.27) for cohort studies. Being a current drinker was associated with an increased liver cancer risk in case–control studies (mRR = 1.55, 95 % CI 0.38–2.73), but not in cohort studies (mRR = 0.86, 95 % CI 0.74–0.97). The dose–response relation between alcohol and liver cancer was apparent with RR = 1.08 (95 % CI 1.04–1.11) for 12 g/day (~1 drink), 1.54 (95 % CI 1.36–1.74) for 50 g/day, 2.14 (95 % CI 1.74–2.62) for 75 g/day, 3.21 (95 % CI 2.34–4.40) for 100 g/day, and 5.20 (95 % CI 3.25–8.29) for 125 g/day of alcohol consumption. There were synergistic effects of alcohol consumption with hepatitis (S = 2.14, 95 % CI 1.31–2.98) and with diabetes (S = 3.57, 95 % CI 2.29–4.84) on the risk of liver cancer, although this may be subject to publication bias. Conclusion : Overall, one alcoholic drink per day (~12 g/day) may be associated with a 1.1 times higher liver cancer risk. Further studies on the synergistic effects of alcohol consumption and other major risk factors are warranted.