Do Kim-Anh, Johnson Marcella M, Lee J Jack, Wu Xi Feng, Dong Qiong, Hong Waun K, Khuri Fadlo R, Spitz Margaret R
Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Cancer. 2004 Dec 15;101(12):2837-42. doi: 10.1002/cncr.20714.
The authors set out to assess the correlation between smoking-related second primary tumor (SPT) development and cigarette smoking habits after diagnosis and definitive treatment in patients with early-stage head and neck squamous cell carcinoma who were enrolled in a placebo-controlled randomized chemoprevention trial of 13-cis-retinoic acid.
Longitudinal data collected for 10 years after the index diagnosis are presented for 1190 patients. Cox proportional hazards regression models were used to examine the effects of changes in smoking behavior on smoking-related SPT development.
One-third of all patients who quit smoking within 12 months before randomization experienced recurrence, compared with 6.9% and 10.4% of all never-smokers and former smokers, respectively. Approximately 16% of all current smokers stopped smoking, and nearly 22% of current smokers developed SPTs, compared with 14.5%, 13.2%, and 8.8% of all recent smokers, former smokers, and never-smokers, respectively. The probability of developing a smoking-related SPT was highest among patients who were current smokers at randomization. These patients, regardless of whether they ceased smoking during follow-up, were nearly three times more likely than patients who had never smoked to develop a smoking-related SPT. In contrast, former smokers and recent quitters who continued to abstain from smoking during follow-up were approximately 1.5 times more likely to develop an SPT compared with patients who had never smoked.
Patients who continue to smoke after the successful treatment of their index head and neck malignancies have a substantially higher risk of developing smoking-related SPTs.
作者旨在评估在一项13 - 顺式维甲酸安慰剂对照随机化学预防试验中入组的早期头颈部鳞状细胞癌患者确诊并接受确定性治疗后，吸烟相关第二原发性肿瘤（SPT）的发生与吸烟习惯之间的相关性。
呈现了1190例患者在索引诊断后10年收集的纵向数据。采用Cox比例风险回归模型来检验吸烟行为变化对吸烟相关SPT发生的影响。
在随机分组前12个月内戒烟的所有患者中，三分之一经历了复发，而所有从不吸烟者和既往吸烟者的复发率分别为6.9%和10.4%。所有当前吸烟者中约16%停止吸烟，近22%的当前吸烟者发生了SPT，而所有近期吸烟者、既往吸烟者和从不吸烟者的发生率分别为14.5%、13.2%和8.8%。在随机分组时为当前吸烟者的患者中，发生吸烟相关SPT的概率最高。这些患者，无论在随访期间是否戒烟，发生吸烟相关SPT的可能性比从不吸烟者高近三倍。相比之下，在随访期间继续戒烟的既往吸烟者和近期戒烟者发生SPT的可能性比从不吸烟者高约1.5倍。
在成功治疗其索引头颈部恶性肿瘤后继续吸烟的患者发生吸烟相关SPT的风险显著更高。
