Yuan Chen, Morales-Oyarvide Vicente, Babic Ana, Clish Clary B, Kraft Peter, Bao Ying, Qian Zhi Rong, Rubinson Douglas A, Ng Kimmie, Giovannucci Edward L, Ogino Shuji, Stampfer Meir J, Gaziano John Michael, Sesso Howard D, Cochrane Barbara B, Manson JoAnn E, Fuchs Charles S, Wolpin Brian M
Chen Yuan, Vicente Morales-Oyarvide, Ana Babic, Zhi Rong Qian, Douglas A. Rubinson, Kimmie Ng, Shuji Ogino, Charles S. Fuchs, and Brian M. Wolpin, Dana-Farber Cancer Institute and Harvard Medical School; Chen Yuan, Peter Kraft, Edward L. Giovannucci, Shuji Ogino, Meir J. Stampfer, Howard D. Sesso, and JoAnn E. Manson, Harvard School of Public Health; Ying Bao, Edward L. Giovannucci, Shuji Ogino, Meir J. Stampfer, John Michael Gaziano, Howard D. Sesso, JoAnn E. Manson, and Charles S. Fuchs, Brigham and Women's Hospital and Harvard Medical School; John Michael Gaziano, Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston; Clary B. Clish, Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA; and Barbara B. Cochrane, University of Washington School of Nursing, Seattle, WA.
J Clin Oncol. 2017 Jun 1;35(16):1822-1828. doi: 10.1200/JCO.2016.71.2026. Epub 2017 Mar 30.
Purpose Cigarette smoking is associated with increased incidence of pancreatic cancer. However, few studies have prospectively evaluated the association of smoking with patient survival. Patients and Methods We analyzed survival by smoking status among 1,037 patients from two large US prospective cohort studies diagnosed from 1986 to 2013. Among 485 patients from four prospective US cohorts, we also evaluated survival by prediagnostic circulating levels of cotinine, a metabolite of nicotine that is proportional to tobacco smoke exposure. On the basis of prediagnosis cotinine levels, we classified patients as nonsmokers (< 3.1 ng/mL), light smokers (3.1-20.9 ng/mL), or heavy smokers (≥ 21.0 ng/mL). We estimated hazard ratios (HRs) for death by using Cox proportional hazards models, with adjustment for age, sex, race/ethnicity, body mass index, diabetes status, diagnosis year, and cancer stage. Results The multivariable-adjusted HR for death was 1.37 (95% CI, 1.11 to 1.69) comparing current smokers with never smokers ( P = .003). A statistically significant negative trend in survival was observed for increasing pack-years of smoking ( P = .008), with HR for death of 1.49 (95% CI, 1.05 to 2.10) for > 60 pack-years of smoking versus never smoking. Survival among former smokers was similar to that for never smokers, regardless of time since quitting. Heavy smokers defined by prediagnostic circulating cotinine levels had a multivariable-adjusted HR for death of 1.76 (95% CI, 1.23 to 2.51) compared with nonsmokers. Among patients with circulating cotinine levels measured within 5 years before diagnosis, heavy smokers had a multivariable-adjusted HR for death of 2.47 (95% CI, 1.24 to 4.92) compared with nonsmokers. Conclusion Cigarette smoking was associated with a reduction in survival among patients with pancreatic cancer.
目的 吸烟与胰腺癌发病率增加有关。然而，很少有研究前瞻性地评估吸烟与患者生存率之间的关联。患者与方法 我们分析了1986年至2013年期间诊断的来自两项美国大型前瞻性队列研究的1037例患者按吸烟状况的生存率。在来自四项美国前瞻性队列的485例患者中，我们还通过诊断前可替宁（尼古丁的一种代谢产物，与烟草烟雾暴露量成正比）的循环水平评估了生存率。根据诊断前可替宁水平，我们将患者分为非吸烟者（<3.1 ng/mL）、轻度吸烟者（3.1 - 20.9 ng/mL）或重度吸烟者（≥21.0 ng/mL）。我们使用Cox比例风险模型估计死亡风险比（HRs），并对年龄、性别、种族/族裔、体重指数、糖尿病状态、诊断年份和癌症分期进行了调整。结果 与从不吸烟者相比，当前吸烟者的多变量调整后死亡HR为1.37（95%CI，1.11至1.69）（P = 0.003）。观察到吸烟包年数增加时生存率存在统计学显著的负向趋势（P = 0.008），吸烟超过60包年与从不吸烟相比，死亡HR为1.49（95%CI，1.05至2.10）。既往吸烟者的生存率与从不吸烟者相似，与戒烟时间无关。根据诊断前循环可替宁水平定义的重度吸烟者与非吸烟者相比，多变量调整后死亡HR为1.76（95%CI，1.23至2.51）。在诊断前五年内测量了循环可替宁水平的患者中，重度吸烟者与非吸烟者相比，多变量调整后死亡HR为2.47（95%CI，1.24至4.92）。结论 吸烟与胰腺癌患者生存率降低有关。
