曾吸烟者膀胱癌风险持续存在：来自当代前瞻性队列研究的结果。
Persistence of urothelial carcinoma of the bladder risk among former smokers: results from a contemporary, prospective cohort study.
机构信息
Department of Urology, University of Washington, Seattle, WA.
Department of Urology, University of Washington, Seattle, WA; Program in Epidemiology, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA.
出版信息
Urol Oncol. 2014 Jan;32(1):25.e21-5. doi: 10.1016/j.urolonc.2012.09.001. Epub 2013 Mar 15.
OBJECTIVES
Cigarette smoking is a known risk factor for urothelial carcinoma (UC) of the bladder. However, the persistence of an increased risk for UC following smoking cessation is not well established. We assessed the risk of UC among former smokers using a recent, prospective cohort with a high proportion of former smokers.
MATERIALS AND METHODS
Study participants were members of the VITamins And Lifestyle cohort (VITAL), a group of 77,719 men and women between the ages of 50 and 76 years from western Washington State. Smoking history and other risk factors were obtained at the time of recruitment. The primary outcome was a new diagnosis of UC (n =385), as determined through linkage to a population-based cancer registry.
RESULTS AND LIMITATIONS
The cohort included 8% current and 44% former smokers, and among the UC cases, 15% were current and 60% former smokers. Both the current and former smoker had an increased risk of UC compared with never smokers (hazard ratio [HRs]: 3.81; 95% confidence intervals [CI] 2.71-5.35 and 2.0; 95% CI 1.55-2.58, respectively). Among former smokers, the risk of UC increased with the pack-years smoked and decreased with the years since quitting. When both the measures of smoking were considered together, the risk of UC was similar for long-term quitters and recent quitters for a given level of pack-years. For example, for those with pack-years of 22.5-37.5, the HR of UC was 1.91 (95% CI 1.17-3.11) for the distant quitters (≥ 23.5 y before baseline) and HR = 1.92 (95% CI 1.26-2.94) among the recent quitters. Limitations include the small number of cases at the extremes of smoking history and errors in self-reported smoking history.
CONCLUSIONS
The risk of bladder cancer in former smokers remains elevated>32 years after quitting, even among those with moderate smoking histories. This argues that a history of smoking confers a lifelong increased risk of UC.
目的
吸烟是膀胱癌（UC）的已知危险因素。然而，戒烟后 UC 风险持续增加的情况尚未得到很好的确立。我们使用最近的一项前瞻性队列研究，该研究中吸烟者比例较高，评估了曾经吸烟者患 UC 的风险。
材料和方法
研究参与者是来自华盛顿州西部的 77719 名年龄在 50 至 76 岁之间的男性和女性，他们是 VITamins And Lifestyle 队列（VITAL）的成员。在招募时获得了吸烟史和其他危险因素。主要结局是通过与基于人群的癌症登记处的链接确定的新诊断的 UC（n = 385）。
结果和局限性
该队列包括 8%的当前吸烟者和 44%的前吸烟者，在 UC 病例中，15%为当前吸烟者，60%为前吸烟者。与从不吸烟者相比，当前吸烟者和前吸烟者患 UC 的风险均增加（风险比[HR]：3.81；95%置信区间[CI]：2.71-5.35 和 2.0；95%CI：1.55-2.58）。在以前的吸烟者中，UC 的风险随着吸烟的包年数增加而增加，随着戒烟年限的增加而减少。当同时考虑两种吸烟测量方法时，对于给定的吸烟包年数，长期戒烟者和近期戒烟者患 UC 的风险相似。例如，对于吸烟包年数为 22.5-37.5 的人群，距离戒烟时间≥23.5 年的远处戒烟者的 UC 风险 HR 为 1.91（95%CI：1.17-3.11），近期戒烟者的 HR 为 1.92（95%CI：1.26-2.94）。局限性包括吸烟史极端情况下的病例数量较少和自我报告吸烟史的错误。
结论
即使在吸烟史处于中等水平的人群中，戒烟 32 年后，前吸烟者患膀胱癌的风险仍然升高。这表明吸烟史会导致终生 UC 风险增加。
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