CIGARETTE-SMOKING AND OTHER BEHAVIORAL RISK-FACTORS FOR RECURRENCE OF COLORECTAL ADENOMATOUS POLYPS (NEW-YORK-CITY, NY, USA)
CIGARETTE-SMOKING AND OTHER BEHAVIORAL RISK-FACTORS FOR RECURRENCE OF COLORECTAL ADENOMATOUS POLYPS (NEW-YORK-CITY, NY, USA)
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DOI：
10.1007/bf01830239
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发表时间：
1994-05-01
影响因子：
2.3
通讯作者：
AHSAN, H
中科院分区：
文献类型：
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作者：
JACOBSON, JS;NEUGUT, AI;AHSAN, H
腺瘤性息肉(以下简称腺瘤)是结直肠癌的先兆。吸烟与腺瘤有关，但与结直肠癌无关，而在一些研究中，酒精和脂肪摄入与腺瘤和癌症都有关。在切除的腺瘤患者中，大约30%的人在三年内再次发展为腺瘤。这项病例对照研究探讨了吸烟与腺瘤复发的关系。1986年4月至1988年3月，我们对纽约市(NY，美国)三家诊所的35岁至84岁的结肠镜检查患者进行了问卷调查。我们比较了186例复发性息肉病例(130名男性，56名女性)和330名对照组(187名男性，143名女性)，这些患者有息肉切除史，但随访正常，并对可能的混杂因素进行了吸烟年限的调整。在男性(OR=1.8，95%可信区间[CI]=1.0-3.4)和女性(OR=3.6，CI=1.7-7.6)中，吸烟者中最高四分之一的吸烟者发生异时性或复发腺瘤的风险显著高于不吸烟者。对戒烟时间的调整仅略微降低了风险，对饮食脂肪摄入量的调整也是如此，这本身仍然是显著的。未发现酒精摄入量与复发风险之间的关联。吸烟者似乎有更高的腺瘤复发风险，这种风险并不能通过戒烟完全消除。以腺瘤复发为终点的干预试验应考虑吸烟因素。
Adenomatous polyps (hereinafter referred to as adenomas) are known precursors of colorectal cancer. Cigarette smoking has been associated with adenomas but not with colorectal cancer, while alcohol and fat intake have been associated with both adenomas and cancer in some studies. Approximately 30 percent of patients with resected adenomas develop another adenoma within three years. This case-control study explores the association of cigarette smoking with adenoma recurrence. Between April 1986 and March 1988, we administered a questionnaire to colonoscoped patients aged 35 to 84 years in three New York City (NY, USA) practices. We compared 186 recurrent polyp cases (130 males, 56 females) and 330 controls (187 males, 143 females) who had a history of polypectomy but normal follow-up colonoscopy, by cigarette-smoking pack-years adjusted for possible confounders. Risk for a metachronous or recurrent adenoma was significantly greater in the highest quartile of smokers than in never-smokers among both men (odds ratio [OR] = 1.8, 95 percent confidence interval [CI] = 1.0-3.4) and women (OR = 3.6, CI = 1.7-7.6). Adjustment for time since smoking cessation reduced risk only slightly, as did adjustment for dietary fat intake, which itself remained significant. No association was found between alcohol intake and risk of recurrence. Cigarette smokers appear to have an elevated risk of adenoma recurrence that is not eliminated entirely by smoking cessation. Intervention trials that use adenoma recurrence as an endpoint should take smoking into account.