累积吸烟暴露对挽救性根治性前列腺切除术治疗放射性复发性前列腺癌患者的肿瘤学影响。
Oncologic Effect of Cumulative Smoking Exposure in Patients Treated With Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer.
机构信息
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
出版信息
Clin Genitourin Cancer. 2018 Jun;16(3):e619-e627. doi: 10.1016/j.clgc.2017.10.015. Epub 2017 Nov 10.
INTRODUCTION
The purpose of the present study was to investigate the association of smoking with biochemical recurrence (BCR) and metastasis in radiation-recurrent prostate cancer (PCa) patients undergoing salvage radical prostatectomy (SRP).
PATIENTS AND METHODS
A total of 214 patients treated with SRP for radiation-recurrent PCa in 5 tertiary referral centers were included from January 2007 to December 2015. Kaplan-Meier analyses were used to assess the time to BCR and metastasis. Pre- and postoperative multivariable Cox proportional hazard regression models were fitted.
RESULTS
Overall, 120 (56.1%), 49 (22.9%), and 45 (21%) patients were never, former, and current smokers, respectively. Low-, medium-, and high-cumulative smoking exposure was registered in 59.8%, 16.4%, and 23.8% of cases, respectively. Patients with high cumulative smoking exposure had a significantly greater rate of a pathologic Gleason score of ≥ 8 (P = .01) and extracapsular extension (P = .004). Smoking status, cumulative smoking exposure, intensity, and duration were significantly associated with BCR-free survival (P < .001 for all). Smoking status, cumulative smoking exposure, and smoking intensity were significantly associated with metastasis-free survival (P = .03 for all). High cumulative smoking exposure was independently associated with BCR in both pre- (hazard ratio, 2.23; P = .001) and postoperative (hazard ratio, 1.64; P = .04) multivariable models adjusted for the effects of established clinicopathologic features. Smoking cessation did not affect either BCR- or metastasis-free survival (P = .56 and P = .40, respectively).
CONCLUSION
High cumulative smoking exposure was associated with the biologic and clinical aggressiveness of PCa in patients treated with SRP for radiation-recurrent disease. Smoking is a modifiable risk factor that detrimentally affected the outcomes, even in patients with advanced PCa.
简介
本研究旨在探讨吸烟与接受挽救性前列腺根治切除术（SRP）治疗的放射性复发性前列腺癌（PCa）患者生化复发（BCR）和转移的相关性。
方法
本研究共纳入 2007 年 1 月至 2015 年 12 月在 5 家三级转诊中心接受 SRP 治疗的 214 例放射性复发性 PCa 患者。采用 Kaplan-Meier 分析法评估 BCR 和转移时间。术前和术后多变量 Cox 比例风险回归模型进行拟合。
结果
总体而言，120 例（56.1%）、49 例（22.9%）和 45 例（21%）患者分别为从不吸烟、曾经吸烟和当前吸烟。低、中、高累积吸烟暴露分别在 59.8%、16.4%和 23.8%的病例中登记。高累积吸烟暴露的患者病理 Gleason 评分≥8 的比例显著更高（P=0.01）和包膜外延伸（P=0.004）。吸烟状况、累积吸烟暴露、吸烟强度和吸烟持续时间与 BCR 无复发生存显著相关（P<0.001）。吸烟状况、累积吸烟暴露和吸烟强度与无转移生存显著相关（P=0.03）。高累积吸烟暴露与术前（风险比，2.23；P=0.001）和术后（风险比，1.64；P=0.04）多变量模型中均与 BCR 独立相关，这些模型均调整了既定临床病理特征的影响。戒烟对 BCR 或无转移生存无影响（P=0.56 和 P=0.40）。
结论
高累积吸烟暴露与接受 SRP 治疗的放射性复发性疾病患者的 PCa 生物学和临床侵袭性相关。吸烟是一种可改变的危险因素，即使在晚期 PCa 患者中，也会对结局产生不利影响。
Zotero 插件