Persistence of urothelial carcinoma of the bladder risk among former smokers: results from a contemporary, prospective cohort study.
Persistence of urothelial carcinoma of the bladder risk among former smokers: results from a contemporary, prospective cohort study.
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DOI：
10.1016/j.urolonc.2012.09.001
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
White E
中科院分区：
文献类型：
--
作者：
Welty CJ;Wright JL;Hotaling JM;Bhatti P;Porter MP;White E
吸烟是膀胱尿路上皮癌（UC）的已知危险因素。然而，戒烟后UC风险增加的持续性尚未得到很好的证实。我们使用一个近期的前瞻性队列研究评估了既往吸烟者中UC的风险，该队列中既往吸烟者比例较高。研究参与者是VITAL和生活方式队列（VITAL）的成员，该队列由来自西部华盛顿州的77,719名年龄在50岁至76岁之间的男性和女性组成。在招募时获得吸烟史和其他风险因素。主要结局是UC的新诊断（n = 385），通过与基于人群的癌症登记研究的关联确定。该队列包括8%的当前吸烟者和44%的既往吸烟者，在UC病例中，15%的当前吸烟者和60%的既往吸烟者。与从不吸烟者相比，当前和既往吸烟者的UC风险均增加（风险比[HR]：3.81; 95%置信区间[CI]分别为2.71-5.35和2.0; 95% CI 1.55-2.58）。在曾经吸烟者中，UC的风险随着吸烟包年数的增加而增加，随着戒烟后的年数而减少。当这两种吸烟措施一起考虑，UC的风险是类似的长期戒烟者和最近戒烟者为给定水平的包年。例如，对于包年为22.5-37.5的患者，远处戒烟者（基线前≥23.5年）UC的HR为1.91（95% CI 1.17-3.11），近期戒烟者的HR = 1.92（95% CI 1.26-2.94）。局限性包括少数极端吸烟史病例和自我报告吸烟史的错误。在戒烟后32年，前吸烟者患膀胱癌的风险仍然升高，即使是那些有中度吸烟史的人。这表明吸烟史会增加UC的终身风险。
Cigarette smoking is a known risk factor for urothelial carcinoma (UC) of the bladder. However, the persistence of an increased risk for UC following smoking cessation is not well established. We assessed the risk of UC among former smokers using a recent, prospective cohort with a high proportion of former smokers. Study participants were members of the VITamins And Lifestyle cohort (VITAL), a group of 77,719 men and women between the ages of 50 and 76 years from western Washington State. Smoking history and other risk factors were obtained at the time of recruitment. The primary outcome was a new diagnosis of UC (n = 385), as determined through linkage to a population-based cancer registry. The cohort included 8% current and 44% former smokers, and among the UC cases, 15% were current and 60% former smokers. Both the current and former smoker had an increased risk of UC compared with never smokers (hazard ratio [HRs]: 3.81; 95% confidence intervals [CI] 2.71–5.35 and 2.0; 95% CI 1.55–2.58, respectively). Among former smokers, the risk of UC increased with the pack-years smoked and decreased with the years since quitting. When both the measures of smoking were considered together, the risk of UC was similar for long-term quitters and recent quitters for a given level of pack-years. For example, for those with pack-years of 22.5–37.5, the HR of UC was 1.91 (95% CI 1.17–3.11) for the distant quitters (≥23.5 y before baseline) and HR = 1.92 (95% CI 1.26–2.94) among the recent quitters. Limitations include the small number of cases at the extremes of smoking history and errors in self-reported smoking history. The risk of bladder cancer in former smokers remains elevated >32 years after quitting, even among those with moderate smoking histories. This argues that a history of smoking confers a lifelong increased risk of UC.
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影响因子：
5
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