Abstract
BackgroundIn recent years, epidemiologic studies have reported controversial results relating cigarette smoking to myelodysplastic syndromes (MDS) risk. A meta-analysis was performed to assess such potential relationship between cigarette smoking and incidence of MDS.MethodsA search of literature published before October 2012 for observational studies evaluating the association between cigarette smoking and MDS, returned 123 articles and of these, 14 were selected for this study. The outcomes from these studies were calculated and reported as odds ratios (OR). Quality assessments were performed with the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the I2 index and source of heterogeneity was detected by sensitivity analyses. Finally, publication bias was assessed through visual inspection of funnel plots and Egger’s test.ResultsThe pooled OR of developing MDS in ever-smokers was 1.45 (95% CI, 1.25 to 1.68) versus non-smokers. Current and former smokers had increased risks of MDS, with ORs of 1.81 (95% CI, 1.24 to 2.66) and 1.67 (95% CI, 1.42 to 1.96), respectively. In subset analyses, ever-smokers had increased risks of developing MDS if they were living in the United States, or in Europe, female in gender, had refractory anemia (RA)/RA with ringed sideroblasts (RARS) or RA with excess blasts (RAEB)/RAEB in transformation (RAEBt), respectively. Our results demonstrated that the association was stronger in individuals who smoked ≥20 cigarettes/day (OR, 1.62; 95% CI, 1.03 to 2.55) versus those who smoked <20 cigarettes/day (OR, 1.36; 95% CI, 1.13 to 1.64). Moreover, individuals who smoked more than 20 pack-years had increased MDS risk (OR, 1.94; 95% CI, 1.29 to 2.92).ConclusionOur outcomes show that smoking increases the risk of developing MDS in ever-smokers who are current or former smokers. We also demonstrate here that positive association between cigarette smoking and risk of MDS exists, and occurs in a dose-dependent manner.
Highlights
Myelodysplastic syndromes (MDS) are a heterogeneous group of neoplastic clonal stem cell malignancies that present clinically as anemia, thrombocytopenia, leucopenia, and ineffective bone marrow hematopoiesis
Literature Search Systematic literature search was conducted by two independent reviewers (Chao Hu and Mengxia Yu) in PubMed, the Cochrane Library and Embase database for papers published before October 2012
Five studies reported a positive association between incidence of myelodysplastic syndromes (MDS) and smoking [9,13,15,18,19]
Summary
Myelodysplastic syndromes (MDS) are a heterogeneous group of neoplastic clonal stem cell malignancies that present clinically as anemia, thrombocytopenia, leucopenia, and ineffective bone marrow hematopoiesis. Though, MDS has been made using the French– American–British (FAB) classification, with subtypes being refractory anemia (RA), RA with ringed sideroblasts (RARS), RA with excess of blasts (RAEB), RAEB in transformation (RAEB-T), and chronic myelomonocytic leukemia (CMML)[2]. The IPSS incorporates three factors: (1) the percent blasts in the bone marrow, (2) the number of peripheral cytopenias, and (3) the karyotype. According to these factors, a score is calculated which results in placement into an IPSS Risk Group (Low, Intermediate-1, Intermediate-2, or High Risk). Epidemiologic studies have reported controversial results relating cigarette smoking to myelodysplastic syndromes (MDS) risk. A meta-analysis was performed to assess such potential relationship between cigarette smoking and incidence of MDS
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