The negative impact of tobacco smoking on survival after prostate cancer diagnosis
The negative impact of tobacco smoking on survival after prostate cancer diagnosis
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DOI：
10.1007/s10552-015-0624-2
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发表时间：
2015-09-01
影响因子：
2.3
通讯作者：
Zucchetto, Antonella
中科院分区：
文献类型：
--
作者：
Polesel, Jerry;Gini, Andrea;Zucchetto, Antonella
吸烟已被发现会增加健康男性队列中前列腺癌（PCa）的死亡率，但其对PCa患者预后的影响仍不清楚。本研究调查了吸烟对前列腺癌诊断后长期生存的作用。一项回顾性队列研究包括780名先前（1995年至2002年）作为病例纳入意大利病例对照研究的前列腺癌患者。通过健康档案检索了截至2013年（中位随访13年）的生命状态和死亡原因信息。使用考克斯模型计算全因和PCa特异性死亡的风险比（HR）和相应的95%置信区间（CI），校正Gleason评分和主要混杂因素。与从不吸烟者相比，在PCa诊断时吸烟者报告全因（HR = 1.5，95% CI 1.1-2.2）和PCa死亡（HR = 2.0，95% CI 1.0-3.8）风险增加。根据吸烟强度出现剂量反应效应（> 15支香烟/天的HR：1.9，95% CI 1.3-3.0，所有原因; 2.3，95% CI 1.1-4.9，PCa）和持续时间（> 45岁的HR：所有原因为1.7，95%CI 1.1-2.6，PCa为2.6，95%CI 1.2-5.5）。相反，在PCa诊断前吸烟者显示PCa死亡风险无统计学显著性升高。吸烟的影响在Gleason评分的分层中是一致的。无论Gleason评分如何，诊断为PCa时的当前吸烟对PCa特异性长期生存率有负面影响。我们的研究结果表明，吸烟可能是一个可改变的危险因素，以改善预后的男性诊断为PCa。
Tobacco smoking has been found to increase prostate cancer (PCa) mortality in cohorts of healthy men, but its effects on prognosis of men with PCa are still unclear. This study investigated the role of smoking on long-term survival after PCa diagnosis.A retrospective cohort including 780 men with incident PCa previously enrolled (between 1995 and 2002) as cases in an Italian case-control study. Information on vital status up to 2013 (median follow-up 13 years) and cause of death were retrieved through health archives. Hazard ratios (HRs) of all-cause and PCa-specific death, and corresponding 95 % confidence intervals (CIs), were calculated using Cox models, adjusting for Gleason score and major confounders.Out of 263 PCa deceased patients, 81 died because of PCa. Smokers at PCa diagnosis reported increased risks of all-cause (HR = 1.5, 95 % CI 1.1-2.2) and PCa death (HR = 2.0, 95 % CI 1.0-3.8), as compared to never smokers. Dose-response effects emerged according to smoking intensity (HRs for > 15 cigarettes/day: 1.9, 95 % CI 1.3-3.0, for all causes and 2.3, 95 % CI 1.1-4.9, for PCa) and duration (HRs for > 45 years: 1.7, 95 % CI 1.1-2.6, for all causes and 2.6, 95 % CI 1.2-5.5, for PCa). Conversely, former smokers at PCa diagnosis showed no statistically significant higher risks of PCa death. The effects of smoking were consistent in strata of Gleason score.Current smoking at PCa diagnosis negatively impacted PCa-specific, long-term survival, regardless of Gleason score. Our findings suggest that smoking could be a modifiable risk factor to improve prognosis of men diagnosed with PCa.