吸烟会影响晚期非小细胞肺癌患者的治疗效果。

Smoking affects treatment outcome in patients with advanced nonsmall cell lung cancer.

作者信息

Tsao Anne S, Liu Diane, Lee J Jack, Spitz Margaret, Hong Waun Ki

机构信息

Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

出版信息

Cancer. 2006 Jun 1;106(11):2428-36. doi: 10.1002/cncr.21884.

DOI:10.1002/cncr.21884

PMID:16634096

Abstract

BACKGROUND

The purpose of the current study was to determine whether smoking during chemotherapy or chemoradiation therapy for nonsmall cell lung cancer (NSCLC) affects treatment outcome.

METHODS

The authors reviewed the medical records of patients with NSCLC (AJCC Stage III or IV) who were treated with frontline chemotherapy or chemoradiation therapy at the University of Texas M. D. Anderson Cancer Center between January 1993 and December 2002. Treatment type, response, progression-free survival, and overall survival (OS) were correlated with patient demographic characteristics, clinical features, and smoking habits at the time of diagnosis and during therapy.

RESULTS

Of 1370 patients who were eligible for analysis, 497 received chemoradiation therapy and 873 received chemotherapy. In the chemoradiation group, 6% of patients were never-smokers, 45% were former smokers, and 49% were current smokers. Multivariate analysis demonstrated no prognostic effect of smoking status on treatment response or OS rates in the chemoradiation therapy group. In the chemotherapy group, 16% of patients were never-smokers, 42% were former smokers, and 42% were current smokers; 20% of patients continued to smoke during therapy. Never-smokers had higher response rates (19% vs. 8% vs. 12%; P=.004) and lower rates of progressive disease (49% vs. 65% vs. 66%; P=.002) than former and current smokers, respectively. The OS rates were found to be higher among never-smokers (P<0001), women (P=.002), and those with a better Eastern Cooperative Oncology Group (ECOG) performance status (P<.0001). The multivariate Cox model indicated that with adjustment for age, gender, stage of disease, and ECOG performance status, the hazard ratio was 1.47 for former smokers (P=.003) and 1.55 for current smokers (P=.0004). Active smoking during therapy did not appear to impact outcome.

CONCLUSIONS

Never-smokers were found to have an improved outcome over smokers when treated with chemotherapy.

摘要

背景

本研究的目的是确定非小细胞肺癌（NSCLC）化疗或放化疗期间吸烟是否会影响治疗结果。

方法

作者回顾了1993年1月至2002年12月在德克萨斯大学MD安德森癌症中心接受一线化疗或放化疗的NSCLC（美国癌症联合委员会III期或IV期）患者的病历。治疗类型、反应、无进展生存期和总生存期（OS）与患者的人口统计学特征、临床特征以及诊断时和治疗期间的吸烟习惯相关。

结果

在1370例符合分析条件的患者中，497例接受了放化疗，873例接受了化疗。在放化疗组中，6%的患者从不吸烟，45%为既往吸烟者，49%为当前吸烟者。多因素分析表明，吸烟状态对放化疗组的治疗反应或OS率无预后影响。在化疗组中，16%的患者从不吸烟，42%为既往吸烟者，42%为当前吸烟者；20%的患者在治疗期间继续吸烟。从不吸烟者的反应率（分别为19%对8%对12%；P=0.004）和疾病进展率（分别为49%对65%对66%；P=0.002）高于既往吸烟者和当前吸烟者。从不吸烟者、女性（P=0.002）以及东部肿瘤协作组（ECOG）体能状态较好者（P<0.0001）的OS率较高。多因素Cox模型表明，在调整年龄、性别、疾病分期和ECOG体能状态后，既往吸烟者的风险比为1.47（P=0.003），当前吸烟者为1.55（P=0.0004）。治疗期间主动吸烟似乎不影响结果。