Cigarette Smoking Prior to First Cancer and Risk of Second Smoking-Associated Cancers Among Survivors of Bladder, Kidney, Head and Neck, and Stage I Lung Cancers
Cigarette Smoking Prior to First Cancer and Risk of Second Smoking-Associated Cancers Among Survivors of Bladder, Kidney, Head and Neck, and Stage I Lung Cancers
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DOI：
10.1200/jco.2014.56.8220
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发表时间：
2014-12-10
影响因子：
45.3
通讯作者：
Morton, Lindsay M.
中科院分区：
文献类型：
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作者：
Shiels, Meredith S.;Gibson, Todd;Morton, Lindsay M.
研究目的：关于癌症幸存者中吸烟和第二次癌症风险的数据是有限的。我们评估了第一次癌症诊断前吸烟与肺癌（I期）、膀胱癌、肾癌和头颈癌幸存者中第二原发吸烟相关癌症风险之间的关联。MethodsData来自5项队列研究的2，552例I期肺癌患者、6，386例膀胱癌患者、3，179例肾癌患者和2，967例头颈癌患者。我们用比例风险回归评估了诊断前吸烟与第二次吸烟相关癌症风险之间的关联，并将这些估计值与所有队列参与者中首次吸烟相关癌症的估计值进行了比较。目前每天吸烟≥ 20支与I期肺癌幸存者中第二次吸烟相关癌症风险增加相关（风险比[HR] = 3.26; 95%CI，0.92 - 11.6）、膀胱癌（HR = 3.67; 95%CI，2.25 - 5.99）、头颈癌（HR = 4.45; 95%CI，2.56 - 7.73）和肾癌（HR = 5.33; 95%CI，2.55 - 11.1）。这些估计值与所有队列参与者中首次吸烟相关癌症的估计值相似（HR = 5.41; 95%CI，5.23至5.61）。第二次吸烟相关癌症的5年累积发病率范围从3%至8%，在这组癌症survivor.ConclusionUnderstanding癌症幸存者中的第二次癌症的危险因素是至关重要的。我们的数据表明，在第一次癌症诊断之前吸烟会增加癌症幸存者的第二次癌症风险，这些幸存者的癌症风险升高可能是由于吸烟率增加。在目前吸烟的I期肺癌、膀胱癌、肾癌和头颈癌幸存者中，吸烟相关癌症的5年累积风险较高，这突出了癌症患者戒烟的重要性。(C)2014年美国临床肿瘤学会
PurposeData on smoking and second cancer risk among cancer survivors are limited. We assessed associations between smoking before first cancer diagnosis and risk of second primary smoking-associated cancers among survivors of lung (stage I), bladder, kidney, and head/neck cancers.MethodsData were pooled from 2,552 patients with stage I lung cancer, 6,386 with bladder cancer, 3,179 with kidney cancer, and 2,967 with head/neck cancer from five cohort studies. We assessed the association between prediagnostic smoking and second smoking-associated cancer risk with proportional hazards regression, and compared these estimates to those for first smoking-associated cancers in all cohort participants.ResultsCompared with never smoking, current smoking of >= 20 cigarettes per day was associated with increased second smoking-associated cancer risk among survivors of stage I lung (hazard ratio [HR] = 3.26; 95% CI, 0.92 to 11.6), bladder (HR = 3.67; 95% CI, 2.25 to 5.99), head/neck (HR = 4.45; 95% CI, 2.56 to 7.73), and kidney cancers (HR = 5.33; 95% CI, 2.55 to 11.1). These estimates were similar to those for first smoking-associated cancer among all cohort participants (HR = 5.41; 95% CI, 5.23 to 5.61). The 5-year cumulative incidence of second smoking-associated cancers ranged from 3% to 8% in this group of cancer survivors.ConclusionUnderstanding risk factors for second cancers among cancer survivors is crucial. Our data indicate that cigarette smoking before first cancer diagnosis increases second cancer risk among cancer survivors, and elevated cancer risk in these survivors is likely due to increased smoking prevalence. The high 5-year cumulative risks of smoking-associated cancers among current smoking survivors of stage I lung, bladder, kidney, and head/neck cancers highlight the importance of smoking cessation in patients with cancer. (C) 2014 by American Society of Clinical Oncology