Xu Yunze, Qi Yicheng, Zhang Jin, Lu Yongning, Song Jiajia, Dong Baijun, Kong Wen, Xue Wei, Huang Yiran
Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200 Pujian Road, Shanghai, 200127, China.
Tumour Biol. 2014 Jul;35(7):6633-40. doi: 10.1007/s13277-014-1862-8. Epub 2014 Apr 4.
Epidemiological evidence suggests that cigarette smoking is the best-established risk factor for renal cell cancer (RCC). However, the effect of smoking on survival of RCC patients remains debated. We therefore conducted a meta-analysis to investigate the impact of smoking status on overall mortality (OM), disease-specific mortality (DSM), overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) in patients with RCC. We searched Medline, Embase, and the Cochrane Central Search Library for published studies that analyzed the effect of smoking on survival or mortality of RCC. We selected 14 articles according to predefined inclusion criteria. The smoking status was categorized into never smokers and ever smokers (former smokers and/or current smokers). Summary hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated with a fixed or random effects model. Overall, 14 studies including 343,993 RCC cases were accepted for meta-analysis. Ever smoking was significantly correlated with OM (HR 1.30, 95 % CI 1.07-1.58), while no associated with poorer DSM (HR 1.23, 95 % CI 0.96-1.57). Further analysis found current (HR 1.57, 95 % CI 1.20-2.06) but not former smoking (HR 1.14, 95 % CI 0.79-1.63) was associated with a significantly increased risk of OM. Meanwhile, current smoking was associated with poorer DSM (HR 1.50, 95 % CI 1.10-2.05) in subgroup analysis. Ever smoking was significantly associated with poorer OS (HR 1.45; 95 % CI 1.00-2.09) and poorer CSS (HR 1.01; 95 % CI 1.00-1.02), compared with never smokers. Current smoking was associated with poorer PFS (HR 2.94, 95 % CI 1.89-4.58). This review provides preliminary evidence that current smoking in a patient with RCC is associated with poorer survival, demonstrating active smoking to be an independent risk for prognosis of RCC. Smoking cessation should be recommended for RCC patients.
流行病学证据表明，吸烟是已确定的肾细胞癌（RCC）的最佳风险因素。然而，吸烟对RCC患者生存率的影响仍存在争议。因此，我们进行了一项荟萃分析，以研究吸烟状况对RCC患者的总死亡率（OM）、疾病特异性死亡率（DSM）、总生存期（OS）、癌症特异性生存期（CSS）和无进展生存期（PFS）的影响。我们在Medline、Embase和Cochrane中央搜索库中搜索了已发表的分析吸烟对RCC生存率或死亡率影响的研究。我们根据预定义的纳入标准选择了14篇文章。吸烟状况分为从不吸烟者和曾经吸烟者（既往吸烟者和/或当前吸烟者）。采用固定或随机效应模型计算95%置信区间（CI）的汇总风险比（HR）。总体而言，14项研究（包括343,993例RCC病例）被纳入荟萃分析。曾经吸烟与总死亡率显著相关（HR 1.30，95%CI 1.07-1.58），而与疾病特异性死亡率升高无关（HR 1.23，95%CI 0.96-1.57）。进一步分析发现，当前吸烟（HR 1.57，95%CI 1.20-2.06）而非既往吸烟（HR 1.14，95%CI 0.79-1.63）与总死亡率显著增加相关。同时，在亚组分析中，当前吸烟与疾病特异性死亡率升高相关（HR 1.50，95%CI 1.10-2.05）。与从不吸烟者相比，曾经吸烟与较差的总生存期（HR 1.45；95%CI 1.00-2.09）和较差的癌症特异性生存期（HR 1.01；95%CI 1.00-1.02）显著相关。当前吸烟与较差的无进展生存期相关（HR 2.94，95%CI 1.89-4.58）。本综述提供了初步证据，表明RCC患者当前吸烟与较差的生存率相关，表明主动吸烟是RCC预后的独立风险因素。建议RCC患者戒烟。
