Curtis Alexandra, Ondracek Rochelle Payne, Murekeyisoni Christine, Kauffman Eric, Mohler James, Marshall James
Department of Biostatistics, University of Iowa, Iowa City, Iowa.
Department of Cancer Prevention, Roswell Park Cancer Institute, Buffalo, New York.
Cancer Med. 2017 Apr;6(4):857-864. doi: 10.1002/cam4.1041. Epub 2017 Mar 20.
Cigarette smoking has been consistently associated with increased risk of overall mortality, but the importance of smoking for patients with prostate cancer (CaP) who are candidates for curative radical prostatectomy (RP) has received less attention. This retrospectively designed cohort study investigated the association of smoking history at RP with subsequent CaP treatment outcomes and overall mortality. A total of 1981 patients who underwent RP at Roswell Park Cancer Institute (RPCI) between 1993 and 2014 were studied. Smoking history was considered as a risk factor for overall mortality as well as for currently accepted CaP treatment outcomes (biochemical failure, treatment failure, distant metastasis, and disease-specific mortality). The associations of smoking status with these outcomes were tested by Cox proportional hazard analyses. A total of 153 (8%) patients died during follow-up. Current smoking at diagnosis was a statistically significant predictor of overall mortality after RP (current smokers vs. former and never smokers, hazards ratio 2.07, 95% confidence interval [CI]: 1.36-3.14). This association persisted for overall mortality at 3, 5, and 10 years (odds ratios 2.07 [95% CI: 1.36-3.15], 2.05 [95% CI: 1.35-3.12], and 1.8 [95% CI: 1.18-2.74], respectively). Smoking was not associated with biochemical failure, treatment failure, distant metastasis, or CaP-specific mortality, and the association of smoking with overall mortality did not appear to be functionally related to treatment or biochemical failure, or to distant metastasis. Smoking is a non-negligible risk factor for death among CaP patients who undergo RP; patients who smoke are far more likely to die of causes other than CaP.
吸烟一直与总体死亡率增加相关，但对于适合进行根治性前列腺切除术（RP）的前列腺癌（CaP）患者而言，吸烟的重要性却较少受到关注。这项回顾性设计的队列研究调查了RP时的吸烟史与随后的CaP治疗结果及总体死亡率之间的关联。对1993年至2014年间在罗斯韦尔帕克癌症研究所（RPCI）接受RP的1981例患者进行了研究。吸烟史被视为总体死亡率以及目前公认的CaP治疗结果（生化失败、治疗失败、远处转移和疾病特异性死亡率）的危险因素。通过Cox比例风险分析检验吸烟状态与这些结果之间的关联。共有153例（8%）患者在随访期间死亡。诊断时当前吸烟是RP后总体死亡率的统计学显著预测因素（当前吸烟者与既往吸烟者和从不吸烟者相比，风险比为2.07，95%置信区间[CI]：1.36 - 3.14）。这种关联在3年、5年和10年的总体死亡率中持续存在（优势比分别为2.07 [95% CI：1.36 - 3.15]、2.05 [95% CI：1.35 - 3.12]和1.8 [95% CI：1.18 - 2.74]）。吸烟与生化失败、治疗失败、远处转移或CaP特异性死亡率无关，并且吸烟与总体死亡率的关联似乎在功能上与治疗或生化失败或远处转移无关。吸烟是接受RP的CaP患者死亡的一个不可忽视的危险因素；吸烟患者死于CaP以外原因的可能性要大得多。
