Heavy smoking history interacts with chemoradiotherapy for esophageal cancer prognosis: A retrospective study
Heavy smoking history interacts with chemoradiotherapy for esophageal cancer prognosis: A retrospective study
复制标题
DOI：
10.1111/j.1349-7006.2009.01466.x
复制
发表时间：
2010-04-01
期刊：
影响因子：
5.7
通讯作者：
Tanaka, Hideo
中科院分区：
文献类型：
--
作者：
Shitara, Kohei;Matsuo, Keitaro;Tanaka, Hideo
吸烟是食管癌的一个众所周知的危险因素。然而，很少有报告直接评价吸烟作为食管癌的预后因素。此外，很少有证据表明吸烟是否与食管癌的主要治疗方式相互作用。在这项研究中，我们回顾性分析了2001年至2005年间在我院接受治疗的364例食管鳞状细胞癌患者。背景特征，包括吸烟史，被分析为潜在的预后因素。在363例患者中，76例患者（20.9%）为不吸烟者或轻度吸烟者（非重度吸烟者），而287例患者（79.1%）为重度吸烟者。非重度吸烟者和重度吸烟者的5年生存率分别为61.8%（95%可信区间[CI]: 49.1-72.2）和44.6% （95% CI: 38.2-50.9）。在多变量Cox模型中（调整了年龄、性别、运动状态、饮酒、组织学、肿瘤长度、国际抗癌联盟[UICC]分期和治疗），重度吸烟者与非重度吸烟者的风险比为1.73 （95% CI: 1.12-2.68; P = 0.013）。当我们按治疗方法分层时，仅在接受放化疗的患者中，重度吸烟与较差的生存率显著相关（风险比，2.43;95% CI: 1.38-4.27; P = 0.002）。更重要的是，重度吸烟史与治疗方式之间存在统计学上显著的相互作用（P = 0.041）。我们的研究结果表明，吸烟史与食管癌患者的不良预后密切相关，尤其是那些接受放化疗的患者。需要进一步的研究来解释这种不同的预后。（癌症科学2010；01:1001-1006）
Smoking is a well-known risk factor for esophageal cancer. However, there are few reports that directly evaluate smoking as a prognostic factor for esophageal cancer. Moreover, scarce evidence is available on whether smoking interacts with major treatment modalities of esophageal cancer. In this study we retrospectively analyzed 364 patients with esophageal squamous cell cancer who were treated between 2001 and 2005 at our institution. Background characteristics, including smoking history, were analyzed as potential prognostic factors. Of the 363 patients, 76 patients (20.9%) were non-smokers or light smokers (non-heavy), whereas 287 patients (79.1%) were heavy smokers. The 5-year survival rate for non-heavy smokers and heavy smokers was 61.8% (95% confidence interval [CI]: 49.1-72.2) vs 44.6% (95% CI: 38.2-50.9), respectively. In a multivariate Cox model (adjusted for age, gender, performance status, alcohol consumption, histology, tumor length, International Union Against Cancer [UICC] stage, and treatment), the hazard ratio for heavy smokers in comparison with non-heavy smokers was 1.73 (95% CI: 1.12-2.68; P = 0.013). When we stratified by treatment method, heavy smoking was significantly associated with poor survival only in patients treated by chemoradiotherapy (hazard ratio, 2.43; 95% CI: 1.38-4.27; P = 0.002). More importantly, a statistically significant interaction between heavy smoking history and treatment modality was observed (P = 0.041). Our results indicated that smoking history is strongly associated with poor prognosis in patients with esophageal cancer, especially those treated by chemoradiotherapy. Further investigation is warranted to explain this different prognosis. (Cancer Sci 2010; 101: 1001-1006)