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Smoking and Prostate Cancer Survival and Recurrence

meijin 添加于 2011/6/27 12:51:02  1622次阅读 | 0次推荐 | 0个评论

Context Studies of smoking in relation to prostate cancer mortality or recurrence in prostate cancer patients are limited, with fewprostate cancer–specific outcomes.Objective To assess the relation of cigarette smoking and smoking cessation with overall, prostate cancer–specific, and cardiovasculardisease (CVD) mortality and biochemical recurrence among men with prostate cancer.Design, Setting, and Participants Prospective observational study of 5366 men diagnosed with prostate cancer between 1986 and 2006 in the Health ProfessionalsFollow-Up Study.Main Outcome Measures Hazard ratios (HRs) for overall, prostate cancer–specific, and CVD mortality, and biochemical recurrence, defined by an increasein prostate-specific antigen (PSA) levels.Results There were 1630 deaths, 524 (32%) due to prostate cancer and 416 (26%) to CVD, and 878 biochemical recurrences. Absolutecrude rates for prostate cancer–specific death for never vs current smokers were 9.6 vs 15.3 per 1000 person-years; for all-causemortality, the corresponding rates were 27.3 and 53.0 per 1000 person-years. In multivariable analysis, current vs never smokershad an increased risk of prostate cancer mortality (HR, 1.61; 95% confidence interval [CI], 1.11-2.32), as did current smokerswith clinical stage T1 through T3 (HR, 1.80; 95% CI, 1.04-3.12). Current smokers also had increased risk of biochemical recurrence(HR, 1.61; 95% CI, 1.16-2.22), total mortality (HR, 2.28; 95% CI, 1.87-2.80), and CVD mortality (HR, 2.13; 95% CI, 1.39-3.26).After adjusting for clinical stage and grade (likely intermediates of the relation of smoking with prostate cancer recurrenceand survival), current smokers had increased risk of prostate cancer mortality (HR, 1.38; 95% CI, 0.94-2.03), as did currentsmokers with clinical stage T1 through T3 (HR, 1.41; 95% CI, 0.80-2.49); they also had an increased risk of biochemical recurrence(HR, 1.47; 95% CI, 1.06-2.04). Greater number of pack-years was associated with significantly increased risk of prostate cancermortality but not biochemical recurrence. Current smokers of 40 or more pack-years vs never smokers had increased prostatecancer mortality (HR, 1.82; 95% CI, 1.03-3.20) and biochemical recurrence (HR, 1.48; 95% CI, 0.88-2.48). Compared with currentsmokers, those who had quit smoking for 10 or more years (HR, 0.60; 95% CI, 0.42-0.87) or who have quit for less than 10 yearsbut smoked less than 20 pack-years (HR, 0.64; 95% CI, 0.28-1.45) had prostate cancer mortality risks similar to never smokers(HR, 0.61; 95% CI, 0.42-0.88).Conclusions Smoking at the time of prostate cancer diagnosis is associated with increased overall and CVD mortality and prostate cancer–specificmortality and recurrence. Men who have quit for at least 10 years have prostate cancer–specific mortality risks similar tothose who have never smoked.

作 者:Kenfield, Stacey A.; Stampfer, Meir J.; Chan, June M.; Giovannucci, Edward
期刊名称: JAMA: The Journal of the American Medical Association
期卷页: 06/22/2011 第305卷 第24期 2548~页
学科领域:医学科学 » 肿瘤学 » 肿瘤病因
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原文链接:http://jama.ama-assn.org/content/305/24/2548.short
DOI: 10.1001/jama.2011.879
ISBN: 0098-7484
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