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Dose–response association between cigarette smoking and gastric cancer risk: a systematic review and meta-analysis

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Abstract

This study aims at providing an accurate and up-to-date quantification of the dose–response association between cigarette smoking and gastric cancer (GC) risk, overall and by subsite. We conducted a systematic review and meta-analysis of case–control and cohort studies on the association between cigarette smoking and GC risk published up to January 2023. We estimated pooled relative risks (RR) of GC and its subsites according to smoking status, intensity, duration, and time since quitting. Among 271 eligible articles, 205 original studies were included in this meta-analysis. Compared with never smokers, the pooled RR for GC was 1.53 (95% confidence interval; CI 1.44–1.62; n = 92) for current and 1.30 (95% CI 1.23–1.37; n = 82) for former smokers. The RR for current compared with never smokers was 2.08 (95% CI 1.66–2.61; n = 21) for gastric cardia and 1.48 (95% CI 1.33–1.66; n = 8) for distal stomach cancer. GC risk nonlinearly increased with smoking intensity up to 20 cigarettes/day (RR:1.69; 95% CI 1.55–1.84) and levelled thereafter. GC risk significantly increased linearly with increasing smoking duration (RR: 1.31; 95% CI 1.25–1.37 for 20 years) and significantly decreased linearly with increasing time since quitting (RR: 0.65; 95% CI 0.44–0.95 for 30 years since cessation). The present meta-analysis confirms that cigarette smoking is an independent risk factor for GC, particularly for gastric cardia. GC risk increases with a low number of cigarettes up to 20 cigarettes/day and increases in a dose-dependent manner with smoking duration.

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Acknowledgements

We thank Elisa Borroni, Giulia Peveri, and Xiaoqiu Liu for their contributions in the literature screening process. The research leading to these results has received funding from AIRC under MFAG 2021—ID. 25840 project—P.I. Lugo Alessandra. The work of SG was partially supported by the Italian League Against Cancer (LILT), Milan, Italy.

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Authors and Affiliations

  1. Department of Molecular and Translational Medicine, Università Degli Studi Di Brescia, Brescia, Italy

    Matteo Rota & Claudia Specchia

  2. Department of Medical Epidemiology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy

    Irene Possenti, Valeria Valsassina, Claudia Santucci, Cristina Bosetti, Silvano Gallus & Alessandra Lugo

  3. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Claudia Santucci

  4. Department of Statistics and Quantitative Methods, Università Degli Studi Di Milano-Bicocca, Milan, Italy

    Vincenzo Bagnardi

  5. Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy

    Giovanni Corrao

  6. National Centre of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy

    Giovanni Corrao

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  1. Matteo Rota
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Contributions

S.G. and A.L. had the original idea of the work and designed the innovative methodology for the identification of original publications. I.P., C. Santucci and V.V. identified the articles, screened them for eligibility, and extracted the data, with the help of S.G. and A.L. A.L., I.P. and V.V. performed the statistical analyses. S.G., A.L., I.P. and M.R. drafted the manuscript. V.B., C.B., G.C., C. Santucci, and C. Specchia provided statistical and epidemiological supervision. All authors contributed to critical review, editing, and revision of the manuscript draft, and approval of the final version.

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Rota, M., Possenti, I., Valsassina, V. et al. Dose–response association between cigarette smoking and gastric cancer risk: a systematic review and meta-analysis. Gastric Cancer 27, 197–209 (2024). https://doi.org/10.1007/s10120-023-01459-1

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