Association between cigarette smoking and the susceptibility of acute myeloid leukemia: a systematic review and meta-analysis.

Abstract

To elucidate the association between cigarette smoking and the susceptibility of acute myeloid leukemia (AML). We searched relevant articles from PubMed, Embase, and Cochrane by 1st December, 2018. This meta-analysis included 20 case-control studies, involving 7,538 AML patients and 137,924 healthy controls. Studies reported OR and 95%CI of the correlation between cigarette smoking and AML susceptibility were eligible. Subsequently, the included data were weighted by an inverse variance and analyzed using fixed-effects or random-effects model. Subgroup analysis was conducted based on ethnicities and sources of controls. Heterogeneity test was applied for the included articles. Data analyses were conducted using STATA 12.0. Current smokers (OR=1.42, 95%CI= 1.28-1.57; p=0.392) and ever-smokers (OR=1.16, 95%CI=1.05-1.28; p=0.036) were associated with AML susceptibility. In the subgroup analysis by ethnicity, only current smokers (OR=1.45, 95%CI=1.29-1.63; p=0.371) and ever-smokers (OR=1.16, 95%CI=1.03-1.30; p=0.034) of the Caucasian population were associated with AML susceptibility. Stratified analysis based on SOC (source of controls) indicated increased susceptibility of AML in current smokers (OR=1.43, 95%CI=1.26-1.63; p=0.283) and ever-smokers (OR=1.20, 95%CI=1.07-1.35; p=0.078) of the population-based group. Nevertheless, only current smokers in the hospital-based group had increased susceptibility of AML (OR=1.45, 95%CI=1.19-1.76; p=0.198). The risks of AML in ever-smokers (OR=1.04, 95%CI = 0.81-1.35; p=0.054) of the hospital-based group did not remarkably changed. In this meta-analysis, we confirmed the association between cigarette smoking and onset risk of AML, especially in the Caucasian population. High-quality, large-scale researches are required to be conducted in multi-center hospitals for verification.