2ND CANCERS FOLLOWING ORAL AND PHARYNGEAL CANCERS - ROLE OF TOBACCO AND ALCOHOL
2ND CANCERS FOLLOWING ORAL AND PHARYNGEAL CANCERS - ROLE OF TOBACCO AND ALCOHOL
复制标题
DOI：
10.1093/jnci/86.2.131
复制
发表时间：
1994-01-19
期刊：
影响因子：
--
通讯作者：
FRAUMENI, JF
中科院分区：
文献类型：
--
作者：
DAY, GL;BLOT, WJ;FRAUMENI, JF
背景资料：在口腔癌和咽癌患者中，第二原发癌的发生率非常高，这是众所周知的，但对第二肿瘤危险因素的流行病学研究有限。目的：为了评估吸烟和饮酒与这一高危患者组发生第二次癌症的关系，我们进行了一项巢式病例对照研究。研究方法：1984-1985年，在美国四个地区进行了一项以人群为基础的口腔癌病例对照研究，共纳入1090例患者，随访至1989年6月，以了解第二原发癌的发生情况。烟草和酒精消费的信息从原始访谈中获得，并通过对80例继发性癌症患者和189例性别、研究区域和生存期匹配的无继发性癌症的癌症患者（对照组）进行随访访谈进行更新。结果如下：吸烟和饮酒都增加了患第二种癌症的风险，吸烟的影响比饮酒的影响更明显。吸烟（调整酒精）的优势比（OR）随着吸烟的持续时间和强度而上升，并且在呼吸消化道肿瘤（口腔、咽、食管、喉和肺）中最强，在每天吸烟40支或更多支20年或更长时间的吸烟者中，OR达到4.7（95%置信区间[CI] = 1.4-16）。目前的吸烟者在基线调查时发生第二次呼吸消化道癌症的风险是不吸烟者和前吸烟者的四倍。尽管肿瘤诊断之间的中位间隔较短（27个月）限制了对最近戒烟的影响的观察，但在指标诊断时或之后戒烟或饮酒与风险降低无关。然而，戒烟5年后，风险显著降低。在饮酒者中，第二种癌症的风险是最大的啤酒摄入量，与第二个呼吸消化道癌症的OR为3.8（95%CI = 1.2-12），每周15个或更多的啤酒。结论：口腔癌和咽癌患者的烟草和酒精摄入量最高，最容易发展为第二原发癌。含义：避免吸烟和饮酒不仅是预防原发性口腔癌的最理想方法，也是降低呼吸消化系统继发性癌症风险的最理想方法。
Background: The exceptionally high rate of second primary cancers among patients with oral and pharyngeal cancers is well recognized, yet there has been limited epidemiologic study of risk factors for second tumors. Purpose: To evaluate the relation of smoking and alcohol consumption to the development of second cancers among this high-risk patient group, we conducted a nested case-control study. Methods: A total of 1090 patients enrolled in a 1984-1985 population-based, case-control study of oral cancer in four areas of the United States were followed through June 1989 for the occurrence of second primary cancers. Information on tobacco and alcohol consumption was obtained from the original interviews and was updated by follow-up interviews obtained for 80 case patients with second cancers and 189 sex-, study area-, and survival-matched cancer patients free of second cancers (control subjects). Results: Tobacco smoking and alcohol drinking each contributed to risk of second cancers, with the effects of smoking more pronounced than those of alcohol. The odds ratios (ORs) for smoking (adjusted for alcohol) rose with duration and intensity of smoking and were strongest for tumors of the aerodigestive tract (oral cavity, pharynx, esophagus, larynx, and lungs), with ORs reaching 4.7 (95% confidence interval [CI] = 1.4-16) among smokers of 40 or more cigarettes per day for 20 or more years. Current smokers as of the baseline survey experienced a fourfold increased risk of a second aerodigestive tract cancer relative to nonsmokers and former smokers. No reduction in risk was associated with cessation of smoking or drinking at or after the index diagnosis, although the short median interval (27 months) between tumor diagnoses limited observation of the effects due to recent cessation. Risk was significantly reduced, however, 5 years after smoking cessation. Among drinkers, second cancer risk was greatest for beer intake, with an OR for a second aerodigestive tract cancer of 3.8 (95% CI = 1.2-12) for 15 or more beers per week. Conclusions: Oral and pharyngeal cancer patients with the highest intakes of tobacco and alcohol are the ones most prone to develop second primary cancers. Implications: Avoidance of tobacco smoking and alcohol drinking is the most desirable way not only to prevent primary oral cancers, but also to reduce risk of second cancers of the aerodigestive system.