Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis.
Smoking at time of diagnosis and breast cancer-specific survival: new findings and systematic review with meta-analysis.
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DOI：
10.1186/bcr3646
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发表时间：
2014-04-19
期刊：
影响因子：
--
通讯作者：
Brisson J
中科院分区：
文献类型：
--
作者：
Bérubé S;Lemieux J;Moore L;Maunsell E;Brisson J
在吸烟的乳腺癌女性中，目前尚不清楚吸烟是否会损害她们的生存。我们调查了在加拿大一个中心(1987-2008)接受治疗的5892名浸润性乳腺癌患者的确诊时吸烟与乳腺癌特异性和总生存率的关系。女性被分为从不吸烟者、以前吸烟者或现在吸烟者。根据总吸烟量、吸烟强度和吸烟持续时间对当前吸烟者进行进一步分类。通过与人口死亡率数据的联系来确定死亡人数。采用COX比例风险多因素模型。Meta分析的系统综述将新发现与已发表的结果相结合。与从不吸烟的人相比，确诊时吸烟者的乳腺癌特异性死亡率略高，但没有统计学意义(危险比 = 为1.15，95%可信区间为0.97至1.37)。在目前的吸烟者中，乳腺癌特有的死亡率随着总暴露、吸烟强度和吸烟持续时间的增加而增加(均P<0.05)。与从不吸烟的人相比，重度吸烟者(吸烟超过30包，每天吸烟超过20支，或吸烟超过30年)的乳腺癌特异性死亡率高出32%至56%。确诊时吸烟与全因死亡率增加有关。对所有研究的荟萃分析表明，在确诊时吸烟的乳腺癌妇女中，乳腺癌死亡率比从不吸烟的妇女高33%(危险比 = 为1.33，95%CI：1.12至1.58)。到目前为止的现有证据表明，确诊时吸烟与总体生存率和乳腺癌特异性生存率的降低有关。需要研究确诊后戒烟对乳腺癌特定结局的影响。
In women with breast cancer who smoke, it is unclear whether smoking could impair their survival from the disease. We examined the relation of smoking at diagnosis to breast cancer-specific and overall survival among 5,892 women with invasive breast cancer treated in one Canadian center (1987 to 2008). Women were classified as never, former or current smokers. Current smokers were further classified according to total, intensity and duration of smoking. Deaths were identified through linkage to population mortality data. Cox proportional-hazards multivariate models were used. A systematic review with meta-analysis combines new findings with published results. Compared with never smokers, current smokers at diagnosis had a slightly, but not statistically significant, higher breast cancer-specific mortality (hazard ratio = 1.15, 95% confidence interval (CI): 0.97 to 1.37). Among current smokers, breast cancer-specific mortality increased with total exposure to, intensity and duration of smoking (all Ptrend <0.05). Compared to never smokers, breast cancer-specific mortality was 32 to 56% higher among heavy smokers (more than 30 pack years of smoking, more than 20 cigarettes per day or more than 30 years of smoking). Smoking at diagnosis was associated with an increased all-cause mortality rate. A meta-analysis of all studies showed a statistically significant, 33% increased mortality from breast cancer in women with breast cancer who are smokers at diagnosis compared to never smokers (hazard ratio = 1.33, 95% CI: 1.12 to 1.58). Available evidence to date indicates that smoking at diagnosis is associated with a reduction of both overall and breast cancer-specific survival. Studies of the effect of smoking cessation after diagnosis on breast cancer-specific outcomes are needed.
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