Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis.
Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis.
复制标题
早期肺癌诊断后戒烟对预后的影响：荟萃分析的观察性研究系统评价。
DOI：
10.1136/bmj.b5569
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发表时间：
2010-01-21
期刊：
影响因子：
--
通讯作者：
Aveyard P
中科院分区：
文献类型：
--
作者：
Parsons A;Daley A;Begh R;Aveyard P
目的系统回顾原发性肺肿瘤诊断后戒烟对预后影响的证据。设计系统综述和荟萃分析。数据来源CINAHL（1981年），Embase（1980年），Medline（1966年），Web of Science（1966年），CENTRAL（1977年）至2008年12月，以及纳入研究的参考文献列表。研究选择随机对照试验或观察性纵向研究，测量诊断肺癌后戒烟对预后结果的影响，无论表现阶段或肿瘤组织学如何。数据提取两名研究人员独立确定纳入研究并提取数据。使用随机效应模型合并估计值，并使用I2统计量检查异质性。寿命表被用来模拟早期非小细胞肺癌和局限期小细胞肺癌的五年生存率，使用从本综述中获得的持续吸烟者和戒烟者的死亡率。结果在9/10的纳入研究中，大多数患者被诊断为早期肺部肿瘤。持续吸烟与全因死亡风险显著增加相关（风险比2.94，95%置信区间1.15至7.54）和复发（1.86，1.01至3.41）在早期非小细胞肺癌和全因死亡率（1.86，1.33 ~ 2.59）、发展第二原发肿瘤（4.31，1.09 ~ 16.98）和局限期小细胞肺癌复发（1.26，1.06 ~ 1.50）。没有研究包含戒烟对癌症特定死亡率或非小细胞肺癌中第二原发肿瘤发展的影响的数据。根据这些数据建立的生命表模型估计，65岁的早期非小细胞肺癌患者中，继续吸烟的患者的5年生存率为33%，而戒烟者的5年生存率为70%。在有限阶段的小细胞肺癌中，估计29%的持续吸烟者将存活五年，而戒烟者的这一比例为63%。结论本综述为早期肺癌诊断后戒烟改善预后提供了初步证据。根据生命表模型，预防的死亡人数估计数大于戒烟后心肺死亡减少的预期，因此死亡率增加的大部分可能是由于癌症进展减少。这些发现表明，为早期肺癌患者提供戒烟治疗可能是有益的。
Objective To systematically review the evidence that smoking cessation after diagnosis of a primary lung tumour affects prognosis. Design Systematic review with meta-analysis. Data sources CINAHL (from 1981), Embase (from 1980), Medline (from 1966), Web of Science (from 1966), CENTRAL (from 1977) to December 2008, and reference lists of included studies. Study selection Randomised controlled trials or observational longitudinal studies that measured the effect of quitting smoking after diagnosis of lung cancer on prognostic outcomes, regardless of stage at presentation or tumour histology, were included. Data extraction Two researchers independently identified studies for inclusion and extracted data. Estimates were combined by using a random effects model, and the I2 statistic was used to examine heterogeneity. Life tables were used to model five year survival for early stage non-small cell lung cancer and limited stage small cell lung cancer, using death rates for continuing smokers and quitters obtained from this review. Results In 9/10 included studies, most patients studied were diagnosed as having an early stage lung tumour. Continued smoking was associated with a significantly increased risk of all cause mortality (hazard ratio 2.94, 95% confidence interval 1.15 to 7.54) and recurrence (1.86, 1.01 to 3.41) in early stage non-small cell lung cancer and of all cause mortality (1.86, 1.33 to 2.59), development of a second primary tumour (4.31, 1.09 to 16.98), and recurrence (1.26, 1.06 to 1.50) in limited stage small cell lung cancer. No study contained data on the effect of quitting smoking on cancer specific mortality or on development of a second primary tumour in non-small cell lung cancer. Life table modelling on the basis of these data estimated 33% five year survival in 65 year old patients with early stage non-small cell lung cancer who continued to smoke compared with 70% in those who quit smoking. In limited stage small cell lung cancer, an estimated 29% of continuing smokers would survive for five years compared with 63% of quitters on the basis of the data from this review. Conclusions This review provides preliminary evidence that smoking cessation after diagnosis of early stage lung cancer improves prognostic outcomes. From life table modelling, the estimated number of deaths prevented is larger than would be expected from reduction of cardiorespiratory deaths after smoking cessation, so most of the mortality gain is likely to be due to reduced cancer progression. These findings indicate that offering smoking cessation treatment to patients presenting with early stage lung cancer may be beneficial.
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影响因子：
9.6
作者：
Khuder, SA;Mutgi, AB
通讯作者：
Mutgi, AB
影响因子：
9.6
作者：
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影响因子：
5.3
作者：
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通讯作者：
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5.3
作者：
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通讯作者：
Coebergh, JWW