Impact of alcohol consumption on survival in patients with esophageal carcinoma: a large cohort with long-term follow-up.
Impact of alcohol consumption on survival in patients with esophageal carcinoma: a large cohort with long-term follow-up.
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饮酒对食管癌患者生存的影响：大型队列长期随访。
DOI：
10.1111/cas.12552
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发表时间：
2014-12
期刊：
影响因子：
5.7
通讯作者：
Fu J
中科院分区：
文献类型：
--
作者：
Huang Q;Luo K;Yang H;Wen J;Zhang S;Li J;Ela Bella A;Liu Q;Yang F;Zheng Y;Hu R;Chen J;Fu J
酒精是食道癌的一个众所周知的原因，但它对生存的影响却鲜为人知，而且相互矛盾。为了阐明饮酒是否是食道癌生存的独立预测因素，对1997年1月至2008年12月接受手术切除的2151名中国患者进行了跟踪调查，直至2014年3月。用COX比例风险分析评价饮酒对预后的影响。中位随访期为个月。从不饮酒者的中位总生存期(OS；42个月)和无病生存期(DFS；33个月)显著高于从不饮酒者(分别为27个月和22个月)。在根据美国癌症联合委员会制定的标准调整了年龄、体重减轻、分期、手术激进程度、辅助治疗、吸烟状况和性别的多因素COX模型中，曾经饮酒的危险比在OS和DFS分别为1.22(1.06-1.41，P=0.005)和1.16(1.01-1.34，P=0.037)。饮酒对OS和DFS的有害影响随着每天饮酒量的增加而以剂量依赖的方式在统计学上显著增加(趋势P值均为0.05)。在食管腺癌亚组中，饮酒对OS(P=0.596)或DFS(P=0.207)的预测作用不显著。目前的研究表明，那些在诊断为食道鳞状细胞癌之前饮酒的患者的生存期缩短，这与分期、吸烟状况和性别的差异无关。应该强调控制酒精以降低食道癌的死亡率，进一步的结果研究应该包括酒精作为一个潜在的预测因素。
Alcohol is a well-established cause of esophageal carcinoma, but its effect on survival is little known and contradictory. To clarify whether drinking is an independent predictor of survival in esophageal carcinoma, 2151 Chinese patients, receiving surgical resection from January 1997 to December 2008, were followed until March 2014. Cox proportional hazards analysis was applied to evaluate the prognostic effect of alcohol consumption. The median follow-up was 64 months. The median overall survival (OS; 42 months) and disease-free survival (DFS; 33 months) for never-drinkers were significantly higher than ever-drinkers (27 and 22 months, respectively). In the multivariate Cox model that was adjusted for age, weight loss, stage according to criteria set by the American Joint Committee on Cancer, radicality of surgery, adjuvant treatment, smoking status, and gender, the hazard ratios of ever-drinking were 1.22 (1.06–1.41, P = 0.005) on OS, and 1.16 (1.01–1.34, P = 0.037) on DFS. The hazardous effect on OS and DFS of drinking grew statistically significantly in a dose-dependent manner with increasing amount of alcohol consumption per day (both P-value for trend < 0.05). The predictive effect of drinking on OS (P = 0.596) or DFS (P = 0.207) was not significant in the subgroup with esophageal adenocarcinoma (n = 195). The current study revealed that the survival is shortened, of those patients who consume alcohol before diagnosis of esophageal squamous cell carcinoma, which are not attributable to differences in stage, smoking status, and gender. Alcohol control should be emphasized to reduce mortality of esophageal carcinoma, and further outcome studies should include alcohol as a potential prognosticator.
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