Effects of smoking and radiotherapy on lung carcinoma in breast carcinoma survivors
Effects of smoking and radiotherapy on lung carcinoma in breast carcinoma survivors
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DOI：
10.1002/cncr.11669
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发表时间：
2003-10-01
期刊：
影响因子：
6.2
通讯作者：
Bondy, ML
中科院分区：
文献类型：
--
作者：
Ford, MB;Sigurdson, AJ;Bondy, ML
背景胸部放射治疗（XRT）和吸烟的联合作用尚不确定，但它们对某些患者癌症治疗后的肺癌发生具有重要意义。作者分析了吸烟、辐射以及两者暴露对既往接受过乳腺癌治疗的女性肺癌发展的影响。病例患者（n = 280）为美国女性居民，年龄30-89岁，在1960年至1997年诊断为原发性肺癌之前患有乳腺癌。对照组患者（n = 300）是从37,000例在德克萨斯大学M。D.安德森癌症中心和频率匹配的妇女在病例组的基础上，在诊断时的年龄（5年分层），种族，乳腺癌诊断的年份（5年分层），从乳腺癌诊断到肺癌诊断的生存率。采用分层分析和非条件Logistic回归分析，作者评估了吸烟和XRT对肺癌风险的主要和联合作用。在乳腺癌诊断时，84%的病例患者曾经吸烟，而对照组患者为37%，而45%的病例患者和对照组患者接受了乳腺癌XRT。吸烟增加了未使用XRT的女性患肺癌的几率（比值比[OR]，6.0; 95%置信区间[95% CI]，3.6-10.1），但XRT并没有增加非吸烟女性患肺癌的风险（OR，0.5; 95% CI，0.3-1.1）。总体而言，与不使用XRT或吸烟相比，XRT和吸烟的OR为9.0（95% CI，5.1-15.9）。Logistic回归模型得出吸烟主要效应的校正OR为5.6（95% CI，2.9-10.5），XRT主要效应为0.6（95% CI，0.3-1.4），联合效应为8.6（P = 0.08）。吸烟是乳腺癌后肺癌的一个重要独立危险因素，但XRT单独不是。吸烟和XRT结合增强了单独使用的效果，XRT治疗乳腺癌后肺癌的风险显著增加。癌症2003;98：1457-64. (C)2003年美国癌症协会。
BACKGROUND. The combined effects of thoracic radiotherapy (XRT) and cigarette smoking are not known with certainty, but they have important implications for lung carcinogenesis after cancer therapy in some patients. The authors analyzed smoking, radiation, and both exposures on lung carcinoma development in women who were treated previously for breast carcinoma.METHODS. Case patients (n = 280) were female residents of the United States, ages 30-89 years, with breast carcinoma prior to primary lung carcinoma diagnosed between 1960 and 1997. Control patients (n = 300) were selected randomly from 37,000 patients with breast carcinoma who were treated at The University of Texas M. D. Anderson Cancer Center and frequency matched women in the case group based on age at diagnosis (5-year strata), ethnicity, year of breast carcinoma diagnosis (5-year strata), and survival from breast carcinoma diagnosis to lung carcinoma diagnosis. Using stratified analysis and unconditional logistic regression, the authors evaluated the main and combined effects of smoking and XRT on lung carcinoma risk.RESULTS. At the time of breast carcinoma diagnosis, 84% of case patients had ever smoked cigarettes, compared with 37% of control patients, whereas 45% of case patients and control patients received XRT for breast carcinoma. Smoking increased the odds of lung carcinoma in women without XRT (odds ratio [OR], 6.0; 95% confidence interval [95% CI], 3.6-10.1), but XRT did not increase lung carcinoma risk in nonsmoking women (OR, 0.5; 95% CI, 0.3-1.1). Overall, the OR for both XRT and smoking, compared with no XRT or smoking, was 9.0 (95% CI, 5.1-15.9). Logistic regression modeling yielded an adjusted OR of 5.6 for the smoking main effect (95% CI, 2.9-10.5), 0.6 for the XRT main effect (95% CI, 0.3-1.4), and 8.6 (P = 0.08) for the combined effect.CONCLUSIONS. Smoking was a significant independent risk factor for lung carcinoma after breast carcinoma, but XRT alone was not. Smoking and XRT combined enhanced the effect of either alone, with marked increased risks of lung carcinoma after XRT for breast carcinoma. Cancer 2003;98:1457-64. (C) 2003 American Cancer Society.