Cigarette Smoking and Colorectal Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition Study
Cigarette Smoking and Colorectal Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition Study
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DOI：
10.1016/j.cgh.2010.10.012
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发表时间：
2011-02-01
影响因子：
12.6
通讯作者：
Bueno-de-Mesquita, H. Bas
中科院分区：
文献类型：
--
作者：
Leufkens, Anke M.;Van Duijnhoven, Franzel J. B.;Bueno-de-Mesquita, H. Bas
背景与目的：吸烟与结直肠癌（CRC）之间有一致的证据，尽管尚不清楚结肠或直肠对吸烟的影响更敏感。我们调查了吸烟与结直肠癌风险和肿瘤位置的关系。方法：我们分析了欧洲癌症与营养前瞻性调查（EPIC）研究中465,879名参与者的数据；2741人在随访期间（平均8.7年）发展为结直肠癌。采用Cox比例风险回归模型估计风险比（hr）和95%置信区间（ci）。结果：与从不吸烟者相比，曾经吸烟者（HR, 1.18, 95% CI, 1.06-1.32）和曾经吸烟者（HR, 1.21, 95% CI, 1.08-1.36）患结肠癌的风险增加；当前吸烟者的风险增加具有临界意义（HR, 1.13; 95% Cl, 0.98-1.31）。当对肿瘤位置进行分层时，既往吸烟者（HR, 1.25; 95% CI, 1.04-1.50）和当前吸烟者（HR, 1.31; 95% CI, 1.06-1.64）患近端结肠癌的风险增加，但患远端结肠或直肠癌症的风险没有增加。亚位点分析显示，前吸烟者的结肠近端和远端差异无统计学意义（P= 0.45），而目前吸烟者的差异有统计学意义（P= 0.02）。对于戒烟至少20年的吸烟者来说，患结肠癌的风险与从不吸烟者相似。结论：吸烟者患结肠癌的风险增加，结肠癌近端比远端更明显。
BACKGROUND & AIMS: There has been consistent evidence for a relationship between smoking and colorectal cancer (CRC), although it is not clear whether the colon or rectum is more sensitive to the effects of smoking. We investigated the relationships between cigarette smoking and risk of CRC and tumor location. METHODS: We analyzed data from 465,879 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study; 2741 developed CRC during the follow-up period (mean, 8.7 years). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The risk of colon carcinoma was increased among ever smokers (HR, 1.18; 95% CI, 1.06-1.32) and former cigarette smokers (HR, 1.21; 95% CI, 1.08-1.36), compared with never smokers; the increased risk for current smokers was of borderline significance (HR, 1.13; 95% Cl, 0.98-1.31). When stratified for tumor location, the risk of proximal colon cancer was increased for former (HR, 1.25; 95% CI, 1.04-1.50) and current smokers (HR, 1.31; 95% CI, 1.06-1.64), but the risks for cancers in the distal colon or rectum were not. Subsite analyses showed a nonsignificant difference between the proximal and distal colon (P=.45) for former smokers and a significant difference for current smokers (P=.02). For smokers who had stopped smoking for at least 20 years, the risk of developing colon cancer was similar to that of never smokers. CONCLUSIONS: Ever smokers have an increased risk of colon cancer, which appeared to be more pronounced in the proximal than the distal colon location.