Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL 60637, USA.
Cancer. 2013 Aug 1;119(15):2807-14. doi: 10.1002/cncr.28128. Epub 2013 Apr 30.
The objective of this study was to examine the effect of tobacco use on disease control and late gastrointestinal and genitourinary toxicity in men undergoing external beam radiotherapy (EBRT) for prostate cancer.
In total, 633 men with known tobacco history at consultation underwent definitive EBRT between 1988 and 2008. Tobacco use was defined as positive (current or prior) or negative (never). The median EBRT dose was 74 gray (Gy). In univariate analysis, tobacco use and other prognostic factors were compared with disease control and toxicity. Multivariable analysis included tobacco use and the covariates that were associated with outcome on univariate analysis (P < .1).
The rate of 5-year freedom from biochemical failure (FFBF) was 76% for current smokers, 81% for prior smokers, and 87% for never smokers (P < .02). Risk group, the percentage of involved cores, and EBRT dose ≥74 Gy were associated with FFBF (all P < .01). On multivariable analysis, smoking was not associated with FFBF (P = .19). Factors that were associated with late grade ≥2 genitourinary toxicity on univariate analysis included positive tobacco history, intensity-modulated radiotherapy, and EBRT dose ≥74 Gy (all P < .05). Prior transurethral resection of the prostate (P < .01) and current smoking status (P = .06) were associated with grade ≥3 toxicity. On multivariable analysis, a positive tobacco history was associated with grade ≥2 toxicity (hazard ratio, 1.45; P < .02), and current smoking status was associated with grade ≥3 toxicity (hazard ratio, 3.02; P < .05). Tobacco use was not associated with late gastrointestinal toxicity.
In men who are receiving EBRT for prostate cancer, tobacco use may be associated with higher rates of late grade ≥2 toxicity, and current smokers may have higher rates of late grade ≥3 genitourinary toxicity.
本研究旨在探讨吸烟对接受外照射放疗（EBRT）治疗前列腺癌的男性疾病控制和晚期胃肠道及泌尿生殖系统毒性的影响。
共有 633 名在就诊时具有已知吸烟史的男性患者于 1988 年至 2008 年期间接受了根治性 EBRT。吸烟状态定义为阳性（当前或既往）或阴性（从未）。中位 EBRT 剂量为 74 戈瑞（Gy）。在单变量分析中，将吸烟状况和其他预后因素与疾病控制和毒性进行比较。多变量分析包括吸烟状况以及与单变量分析结果相关的协变量（P<.1）。
当前吸烟者、既往吸烟者和从不吸烟者的 5 年生化无失败率（FFBF）分别为 76%、81%和 87%（P<.02）。风险组、受累核心百分比和 EBRT 剂量≥74 Gy 与 FFBF 相关（均 P<.01）。多变量分析显示，吸烟与 FFBF 无关（P=.19）。单变量分析中与晚期≥2 级泌尿生殖系统毒性相关的因素包括阳性吸烟史、调强放疗和 EBRT 剂量≥74 Gy（均 P<.05）。既往经尿道前列腺切除术（P<.01）和当前吸烟状态（P=.06）与≥3 级毒性相关。多变量分析显示，阳性吸烟史与≥2 级毒性相关（风险比，1.45；P<.02），当前吸烟状态与≥3 级毒性相关（风险比，3.02；P<.05）。吸烟与晚期胃肠道毒性无关。
在接受 EBRT 治疗前列腺癌的男性中，吸烟可能与晚期≥2 级毒性发生率较高相关，且当前吸烟者可能具有较高的晚期≥3 级泌尿生殖系统毒性发生率。
