González Carlos A, Pera Guillem, Agudo Antonio, Palli Domenico, Krogh Vittorio, Vineis Paolo, Tumino Rosario, Panico Salvatore, Berglund Göran, Simán Henrik, Nyrén Olof, Agren Asa, Martinez Carmen, Dorronsoro Miren, Barricarte Aurelio, Tormo María J, Quiros Jose R, Allen Naomi, Bingham Sheila, Day Nicholas, Miller Antony, Nagel Gabriele, Boeing Heiner, Overvad Kim, Tjonneland Anne, Bueno-De-Mesquita H Bas, Boshuizen Hendriek C, Peeters Petra, Numans Mattijs, Clavel-Chapelon François, Helen Ishaki, Agapitos Emmanuel, Lund Eiliv, Fahey Michael, Saracci Rodolfo, Kaaks Rudolf, Riboli Elio
Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain.
Int J Cancer. 2003 Nov 20;107(4):629-34. doi: 10.1002/ijc.11426.
Smoking has recently been recognised as causally associated with the development of gastric cancer (GC). However, evidence on the effect by sex, duration and intensity of smoking, anatomic subsite and cessation of smoking is limited. Our objective was to assess the relation between tobacco use and GC incidence in the European Prospective Investigation into Cancer and Nutrition (EPIC). We studied data from 521,468 individuals recruited from 10 European countries taking part in the EPIC study. Participants completed lifestyle questionnaires that included questions on lifetime consumption of tobacco and diet in 1991-1998. Participants were followed until September 2002, and during that period 305 cases of stomach cancer were identified. After exclusions, 274 were eligible for the analysis, using the Cox proportional hazard model. After adjustment for educational level, consumption of fresh fruit, vegetables and preserved meat, alcohol intake and body mass index (BMI), there was a significant association between cigarette smoking and gastric cancer risk: the hazard ratio (HR) for ever smokers was 1.45 (95% confidence interval [CI] = 1.08-1.94). The HR of current cigarette smoking was 1.73 (95% CI = 1.06-2.83) in males and 1.87 (95% CI = 1.12-3.12) in females. Hazard ratios increased with intensity and duration of cigarette smoked. A significant decrease of risk was observed after 10 years of quitting smoking. A preliminary analysis of 121 cases with identified anatomic site showed that current cigarette smokers had a higher HR of GC in the cardia (HR = 4.10) than in the distal part of the stomach (HR = 1.94). In this cohort, 17.6 % (95% CI = 10.5-29.5 %) of GC cases may be attributable to smoking. Findings from this large study support the causal relation between smoking and gastric cancer in this European population. Stomach cancer should be added to the burden of diseases caused by smoking.
吸烟最近被认为与胃癌（GC）的发生存在因果关系。然而，关于吸烟的性别、持续时间和强度、解剖部位以及戒烟对胃癌影响的证据有限。我们的目标是在欧洲癌症与营养前瞻性调查（EPIC）中评估烟草使用与胃癌发病率之间的关系。我们研究了来自参与EPIC研究的10个欧洲国家招募的521,468人的数据。参与者在1991 - 1998年完成了包括终身烟草消费和饮食问题的生活方式问卷。对参与者进行随访直至2002年9月，在此期间确诊了305例胃癌病例。排除后，274例符合使用Cox比例风险模型进行分析的条件。在对教育水平、新鲜水果、蔬菜和腌制肉类的消费、酒精摄入量和体重指数（BMI）进行调整后，吸烟与胃癌风险之间存在显著关联：曾经吸烟者的风险比（HR）为1.45（95%置信区间[CI]=1.08 - 1.94）。当前吸烟者的HR在男性中为1.73（95%CI = 1.06 - 2.83），在女性中为1.87（95%CI = 1.12 - 3.12）。风险比随着吸烟强度和持续时间的增加而升高。戒烟10年后观察到风险显著降低。对121例已确定解剖部位的病例进行的初步分析表明，当前吸烟者在贲门部患胃癌的HR（HR = 4.10）高于胃远端（HR = 1.94）。在这个队列中，17.6%（95%CI = 10.5 - 29.5%）的胃癌病例可能归因于吸烟。这项大型研究的结果支持了在这个欧洲人群中吸烟与胃癌之间的因果关系。胃癌应被纳入吸烟所致疾病负担之中。
