Nasopharyngeal Carcinoma (NPC) Risk Factors: A Systematic Review and Meta-Analysis of the Association with Lifestyle, Diets, Socioeconomic and Sociodemographic in Asian Region

OBJECTIVE: Risk factors of nasopharyngeal carcinoma (NPC) have been linked with diets, life style and viral infections. NPC is more rampant in Asian populations than non-Asian countries. Our study aims to assess the validity of the suggestions provided by multiple case control studies demonstrating that salted fish consumption, smoking and alcohol consumption are associated with the risk of NPC in Asia. METHODS: Search for related literature on salted fish, smoking and alcohol consumption were performed via Science Direct, PubMed databases and Google Scholar. Articles included in this study were from 2009 to 2017, with specific focus on salted fish, smoking and alcohol consumption as risk factors of NPC. This study excluded all articles published prior to 2009 and articles involving other cancers. Data were extracted independently by two different researchers and harmonized. Meta-analysis was conducted on the obtained data, by using R package Meta to create funnel and forest plots. RESULTS: The meta-analysis revealed that salted fish, smoking and alcohol consumption were significantly associated to NPC risk with random effect model score showing OR of 1.41 at 95% confidence interval (CI) of 1.13-1.75 (P<0.01), OR of 1.89 at 95 % CI of 1.49 - 2.38, and OR: 1.42 at 95 % CI of 1.23 - 1.65 respectively. Our results also revealed significant association of salted meat, salted vegetables, house type, wood dust exposure associated with NPC risk with p values less than 0.05. CONCLUSION: This study proposes that salted fish intake, smoking and alcohol consumption might be linked to NPC risk in Asians. Further studies are necessary to ascertain the molecular mechanisms and clarify if the associated path that could function as therapeutic target.