前瞻性队列研究中烟草使用与前列腺癌死亡率及发病率的系统评价和荟萃分析。
A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies.
作者信息
Islami Farhad, Moreira Daniel M, Boffetta Paolo, Freedland Stephen J
机构信息
The Tisch Cancer Institute and Institute for Transitional Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA; Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
The Arthur Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, NY, USA.
出版信息
Eur Urol. 2014 Dec;66(6):1054-64. doi: 10.1016/j.eururo.2014.08.059. Epub 2014 Sep 18.
CONTEXT
An association between tobacco smoking and prostate cancer (PCa) incidence and mortality was suggested in an earlier meta-analysis of 24 prospective studies in which dose-response associations and risks per unit of tobacco use were not examined.
OBJECTIVE
We investigated the association between several measures of tobacco use and PCa mortality (primary outcome) and incidence (secondary outcome) including dose-response association.
EVIDENCE ACQUISITION
Relevant articles from prospective studies were identified by searching the PubMed and Web of Science databases (through January 21, 2014) and reference lists of relevant articles. Combined relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects methods. We also calculated population attributable risk (PAR) for smoking and PCa mortality.
EVIDENCE SYNTHESIS
We included 51 articles in this meta-analysis (11823 PCa deaths, 50349 incident cases, and 4,082,606 cohort participants). Current cigarette smoking was associated with an increased risk of PCa death (RR: 1.24; 95% CI, 1.18-1.31), with little evidence for heterogeneity and publication bias. The number of cigarettes smoked per day had a dose-response association with PCa mortality (p=0.02; RR for 20 cigarettes per day: 1.20). The PAR for cigarette smoking and PCa deaths in the United States and Europe were 6.7% and 9.5%, respectively, corresponding to >10000 deaths/year in these two regions. Current cigarette smoking was inversely associated with incident PCa (RR: 0.90; 95% CI, 0.85-0.96), with high heterogeneity in the results. However, in studies completed in 1995 or earlier (considered as completed before the prostate-specific antigen screening era), ever smoking showed a positive association with incident PCa (RR: 1.06; 95% CI, 1.00-1.12) with little heterogeneity.
CONCLUSIONS
Combined evidence from observational studies shows a modest but statistically significant association between cigarette smoking and fatal PCa. Smoking appears to be a modifiable risk factor for PCa death.
PATIENT SUMMARY
Smoking increases the chance of prostate cancer death. Not smoking prevents this harm and many other tobacco-related diseases.
背景
在一项对24项前瞻性研究的早期荟萃分析中，提示吸烟与前列腺癌（PCa）的发病率和死亡率之间存在关联，但未对剂量反应关系和每单位烟草使用量的风险进行研究。
目的
我们调查了几种烟草使用量指标与PCa死亡率（主要结局）和发病率（次要结局）之间的关联，包括剂量反应关系。
证据获取
通过检索PubMed和Web of Science数据库（截至2014年1月21日）以及相关文章的参考文献列表，确定前瞻性研究的相关文章。使用随机效应方法计算合并相对风险（RRs）和95%置信区间（CIs）。我们还计算了吸烟与PCa死亡率的人群归因风险（PAR）。
证据综合
我们在这项荟萃分析中纳入了51篇文章（11823例PCa死亡病例、50349例新发病例和4082606名队列参与者）。当前吸烟与PCa死亡风险增加相关（RR：1.24；95%CI，1.18 - 1.31），几乎没有异质性和发表偏倚的证据。每日吸烟量与PCa死亡率存在剂量反应关系（p = 0.02；每日吸20支烟的RR：1.20）。在美国和欧洲，吸烟与PCa死亡的PAR分别为6.7%和9.5%，相当于这两个地区每年超过10000例死亡。当前吸烟与PCa新发病例呈负相关（RR：0.90；95%CI，0.85 - 0.96），结果存在高度异质性。然而，在1995年或更早完成的研究（视为在前列腺特异性抗原筛查时代之前完成）中，曾经吸烟与PCa新发病例呈正相关（RR：1.06；95%CI，1.00 - 1.12），几乎没有异质性。
结论
观察性研究的综合证据表明，吸烟与致命性PCa之间存在适度但具有统计学意义的关联。吸烟似乎是PCa死亡的一个可改变的风险因素。
患者总结
吸烟会增加前列腺癌死亡的几率。不吸烟可避免这种危害以及许多其他与烟草相关的疾病。
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