Smoking and lung cancer survival - The role of comorbidity and treatment
Smoking and lung cancer survival - The role of comorbidity and treatment
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DOI：
10.1378/chest.125.1.27
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发表时间：
2004-01-01
期刊：
影响因子：
9.6
通讯作者：
Kvale, P
中科院分区：
文献类型：
--
作者：
Tammemagi, CM;Neslund-Dudas, C;Kvale, P
研究目标：大量研究表明，吸烟与癌症患者预后较差有关。本研究的目的是确定吸烟是否独立预测肺癌患者的生存，或者现有的影响是否是通过合并症和/或治疗介导的。设计和设置：Cox 比例风险分析用于研究 1,155 名肺癌患者的队列，该患者在 1995 年至 1998 年期间在亨利福特健康系统诊断。结果：根据基线协变量、年龄、性别进行调整；根据非法药物使用、不良症状、组织学和分期，吸烟（当前吸烟与以前吸烟/从未吸烟）的风险比 (HR) 为 1.37（95% 置信区间 [CI]，1.18 至 1.59；p < 0.001）。根据基线协变量和 IS 有害合并症进行调整后，吸烟的 HR 为 1.38（95% CI，1.18 至 1.60；p < 0.001），表明吸烟的危险作用不是通过合并症介导的。目前吸烟与治疗呈负相关（任何手术和/或化疗和/或放射治疗与无）[比值比，0.73；比值比，0.73； 95% CI，0.55 至 0.98 (p = 0.03)]。根据基线协变量、合并症和治疗进行调整后，当前吸烟者与以前吸烟者/从不吸烟者的 HR 为 1.26（95% CI，1.08 至 1.47；p = 0.003），治疗导致下降 30.7%（任何治疗与无治疗的 HR，0.40；95% CI，0.33 至 0.48；p < 0.001).结论：诊断时当前吸烟是肺癌生存期缩短的重要独立预测因素。这种效应不能用社会人口/暴露因素、不良症状、组织学、阶段、合并症和治疗来解释，这表明它可能是通过直接生物效应介导的。
Study objectives: Numerous studies indicate, that smoking is associated with poorer outcomes in patients with cancer. The aim of this study was to determine whether smoking independently predicts survival in patients with lung cancer or whether an existent effect is mediated through comorbidity and/or treatment.Design and setting: Cox proportional hazards analysis was used to study a cohort of 1,155 patients with lung cancer diagnosed at the Henry Ford Health System between 1995 and 1998, inclusive.Results: Adjusted for the baseline covariates, age, gender; illicit drug use, adverse symptoms, histology, and stage, the hazard ratio (HR) for smoking (current vs former/never) was 1.37 (95% confidence interval [CI], 1.18 to 1.59; p < 0.001). Adjusted for the baseline covariates and for IS deleterious comorbidities, the HR for smoking was 1.38 (95% CI, 1.18 to 1.60; p < 0.001), indicating that the hazardous effect of smoking was not mediated through comorbidity. Current smoking was inversely associated with treatment (any surgery and/or chemotherapy and/or radiation therapy vs none) [odds ratio, 0.73; 95% CI, 0.55 to 0.98 (p = 0.03)]. Adjusted for baseline covariates, comorbidities and treatment, the HR for current smoker vs former/never was 1.26 (95% CI, 1.08 to 1.47; p = 0.003), a decline of 30.7% explained by treatment (HR for any treatment vs none, 0.40; 95% CI, 0.33 to 0.48; p < 0.001).Conclusions: Current smoking at diagnosis is an important independent predictor of shortened lung cancer survival. That this effect was not explained by sociodemographic/exposure factors, adverse symptoms, histology, stage, comorbidity, and treatment suggests that it may be mediated through direct biological effects.