Alcohol and tobacco use prediagnosis and postdiagnosis, and survival in a cohort of patients with early stage cancers of the oral cavity, pharynx, and larynx.
Alcohol and tobacco use prediagnosis and postdiagnosis, and survival in a cohort of patients with early stage cancers of the oral cavity, pharynx, and larynx.
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DOI：
10.1158/1055-9965.epi-09-0944
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发表时间：
2009-12
期刊：
影响因子：
--
通讯作者：
Goodwin WJ Jr
中科院分区：
文献类型：
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作者：
Mayne ST;Cartmel B;Kirsh V;Goodwin WJ Jr
随着越来越多的人开始从第一次癌症中幸存下来，越来越需要基于科学的建议来提高生存率。对于头颈部癌症的幸存者，在诊断前使用烟草和酒精预测生存率较差;然而，诊断后继续这些行为对死亡率的作用不太清楚，特别是对于更适度的饮酒。要求近期存活的早期头颈癌患者（n=264）回顾性报告其吸烟和饮酒史（诊断前），此后每年前瞻性更新信息。患者平均随访4.2年，观察到62例死亡。诊断前吸烟史剂量依赖性地增加死亡风险;吸烟>60包-年者的风险达到5.4（95%CI =0.7-40.1）。同样，诊断前的酒精史剂量依赖性地增加死亡风险;对于每天饮酒>5杯的人，风险达到4.9（95%CI =1.5-16.3），啤酒和白酒消费解释了这种影响。在调整诊断前暴露后，诊断后继续饮酒（平均每天2.3杯）显著增加风险（RR继续饮酒vs.不饮酒=2.7，95% CI，1.2-6.1），而继续吸烟与非显著更高的风险相关（RR继续吸烟vs.不吸烟=1.8，95% CI，0.9-3.9）。在初步诊断为头颈癌后继续饮用酒精饮料会对生存产生不利影响;应将戒烟努力纳入这些患者的生存护理中。
As more people begin to survive first cancers, there is an increased need for science-based recommendations to improve survivorship. For survivors of head and neck cancer, use of tobacco and alcohol prior to diagnosis predicts poorer survival; however, the role of continuing these behaviors after diagnosis on mortality is less clear, especially for more moderate alcohol consumption. Patients (n=264) who were recent survivors of early stage head and neck cancer were asked to retrospectively report their tobacco and alcohol histories (before diagnosis) with information prospectively updated annually thereafter. Patients were followed for an average of 4.2 years, with 62 deaths observed. Smoking history before diagnosis dose-dependently increased the risk of dying; risks reached 5.4 (95% CI=0.7–40.1) among those with >60 pack-years of smoking. Likewise, alcohol history before diagnosis dose-dependently increased mortality risk; risk reached 4.9 (95% CI=1.5–16.3) for persons who drank >5 drinks/day, an effect explained by beer and liquor consumption. After adjusting for pre-diagnosis exposures, continued drinking (average of 2.3 drinks per day) post-diagnosis significantly increased risk (RR continued drinking vs. no drinking=2.7, 95% CI, 1.2–6.1), while continued smoking was associated with non-significantly higher risk (RR continued smoking vs. no smoking =1.8, 95% CI, 0.9–3.9). Continued drinking of alcoholic beverages after an initial diagnosis of head and neck cancer adversely affects survival; cessation efforts should be incorporated into survivorship care of these patients.