Impact of cigarette smoking on outcome of hepatocellular carcinoma after surgery in patients with hepatitis B.
Impact of cigarette smoking on outcome of hepatocellular carcinoma after surgery in patients with hepatitis B.
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吸烟对乙型肝炎患者肝癌术后预后的影响
DOI：
10.1371/journal.pone.0085077
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Lv Y
中科院分区：
文献类型：
--
作者：
Zhang XF;Wei T;Liu XM;Liu C;Lv Y
背景和目的吸烟是肝细胞癌（HCC）发生的一个潜在危险因素，部分通过与乙型肝炎病毒（HBV）相互作用。我们检验了吸烟可能与hbv相关的HCC复发和治愈性手术后患者生存相关的假设。患者与方法前瞻性收集2008 ~ 2011年302例行根治性肝癌切除术的HBV感染患者的资料。入院时询问吸烟状况和吸烟量（包年，PY）。观察影响无复发生存（RFS）的因素。按危险因素分层的RFS和肝特异性死亡率（LSM）采用log-rank检验进行比较。结果109例为当前吸烟者。目前吸烟者与非吸烟者在肿瘤负荷和手术方式上没有差异。单因素和多因素分析发现，重度吸烟（PY≥20）是hbv相关HCC根治术后复发的最显著因素（p = 0.001），其次是抗hbv治疗（p<0.01）、吸烟（p = 0.028）、手术切缘<1 cm （p = 0.048）和输血>600 ml （p = 0.028）。不吸烟者、戒烟者和当前吸烟者的中位RFS分别为34个月、24个月和26个月（p = 0.033）。当前吸烟者的RFS率和5年累积LSM均显著低于非吸烟者（p = 0.024, p<0.001）。重度吸烟者的RFS显著低于非吸烟者和轻度吸烟者（p<0.001），累积LSM显著高于非吸烟者和轻度吸烟者（p = 0.003和0.001）。此外，与术后戒烟者相比，目前吸烟者术后继续吸烟与较差的RFS和较高的LSM密切相关（p = 0.016和p = 0.003）。结论吸烟史和吸烟量可能是hbv相关性HCC术后复发和LSM的危险因素。对于吸烟者，术后继续吸烟可能加速肿瘤复发和患者死亡。因此，应强烈建议患者术前和术后戒烟。
Background and Objectives Cigarette smoking is a potential risk factor for hepatocellular carcinoma (HCC) initiation, partially through interaction with hepatitis B virus (HBV). We examined the hypothesis that cigarette smoking might be associated with HBV-related HCC recurrence and patient survival after curative surgery. Patients and Methods Data of 302 patients with HBV infection who had undergone curative resection for HCC were prospectively collected from 2008 to 2011. Smoking status and smoking quantity (pack-years, PY) were asked at admission. Factors affecting recurrence-free survival (RFS) were examined. RFS and liver-specific mortality (LSM) stratified by risk factors were compared with log-rank test. Results 109 were current smokers. Current smokers were not different from non-smokers in tumor burden and surgical procedure. Univariate and multivariate analysis identified that heavy smoking (PY ≥20) was the most significant factor associated with HBV-related HCC recurrence after curative surgical resection (p = 0.001), followed by anti-HBV treatment (p<0.01), current smoking (p = 0.028), surgical margin <1 cm (p = 0.048) and blood transfusion >600 ml (p = 0.028). The median RFS in non-smokers, ex-smokers and current smokers was 34 months, 24 months and 26 months, respectively (p = 0.033). Current smokers had significantly worse RFS rate and increased 5-year cumulative LSM than non-smokers (p = 0.024, and p<0.001, respectively). Heavy smokers had significantly worse RFS than non- and light smokers (0<PY<20) (p<0.001, respectively) and higher cumulative LSM than non-smokers and light smokers (p = 0.003 and 0.001, respectively). Furthermore, in current smokers, continuing smoking postoperatively was strongly associated with poorer RFS and higher LSM than those who quit smoking postoperatively (p = 0.016 and p = 0.003, respectively). Conclusions Smoking history and quantity appears to be risk factors for HBV-related HCC recurrence and LSM of patients after surgery. For smokers, continued smoking postoperatively might accelerate tumor recurrence and patient death. Therefore, smoking abstinence should be strongly recommended to patients pre- and postoperatively.
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影响因子：
8.8
作者：
Koh, W-P;Robien, K.;Wang, R.;Govindarajan, S.;Yuan, J-M;Yu, M. C.
通讯作者：
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Peto, R