Preventive Healthcare Center, Kangbuk Samsung Hospital.
Department of Internal Medicine, Division of Gastroenterology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Clin Gastroenterol. 2019 Mar;53(3):e107-e112. doi: 10.1097/MCG.0000000000000997.
We evaluated the association of urinary cotinine-verified smoking status with the risk of colorectal neoplasia (CRN).
Many studies have reported the association between the risk of CRN and smoking status, based on self-reported questionnaires. Although self-reported smoking status may be inaccurate, to our knowledge, no study has yet assessed the association between objective biomarkers of tobacco exposure and the risk of CRN.
A cross-sectional study was conducted on 96,806 asymptomatic examinees who underwent colonoscopy and urinary cotinine measurements as part of a health check-up. Cotinine-verified current smokers were participants having a urinary cotinine level ≥50 ng/mL.
The mean participant age was 38.4 years, and the proportion of cotinine-verified current smokers was 23.0%. Cotinine-verified current smoking was an independent risk factor for CRN [adjusted odds ratio (AOR), 1.49; 95% confidence interval (CI), 1.42-1.56] and advanced CRN (ACRN) (AOR, 1.79; 95% CI, 1.57-2.05). Moreover, the risk of CRN and ACRN increased with increasing cotinine levels. Among self-reported never smokers, cotinine-verified current smokers had a higher risk of CRN (AOR, 1.77; 95% CI, 1.57-2.00) and ACRN (AOR, 1.94; 95% CI, 1.37-2.74) than cotinine-verified never smokers did, whereas among self-reported current smokers, cotinine-verified never smokers had a lower risk of CRN (AOR, 0.78; 95% CI, 0.70-0.87) and ACRN (AOR, 0.71; 95% CI, 0.52-0.98) than cotinine-verified current smokers did.
Cotinine-captured smoking status and metabolic variation exhibit associations with CRN more accurately and objectively than self-reporting does, providing clearer evidence for the role of tobacco in the development of CRN.
我们评估了尿液可替宁验证的吸烟状况与结直肠肿瘤（CRN）风险之间的关联。
许多研究基于自我报告的问卷报告了 CRN 风险与吸烟状况之间的关联。尽管自我报告的吸烟状况可能不准确，但据我们所知，尚无研究评估烟草暴露的客观生物标志物与 CRN 风险之间的关联。
对 96806 名无症状受检者进行了一项横断面研究，这些受检者在健康检查中接受了结肠镜检查和尿液可替宁测量。尿液可替宁水平≥50ng/ml 的参与者被确定为可替宁验证的当前吸烟者。
参与者的平均年龄为 38.4 岁，可替宁验证的当前吸烟者比例为 23.0%。可替宁验证的当前吸烟是 CRN（调整优势比[OR]，1.49；95%置信区间[CI]，1.42-1.56）和高级 CRN（ACRN）（调整 OR，1.79；95%CI，1.57-2.05）的独立危险因素。此外，随着可替宁水平的升高，CRN 和 ACRN 的风险也随之增加。在自我报告的从不吸烟者中，与可替宁验证的从不吸烟者相比，可替宁验证的当前吸烟者患 CRN（调整 OR，1.77；95%CI，1.57-2.00）和 ACRN（调整 OR，1.94；95%CI，1.37-2.74）的风险更高，而在自我报告的当前吸烟者中，与可替宁验证的当前吸烟者相比，可替宁验证的从不吸烟者患 CRN（调整 OR，0.78；95%CI，0.70-0.87）和 ACRN（调整 OR，0.71；95%CI，0.52-0.98）的风险更低。
与自我报告相比，可替宁捕获的吸烟状况和代谢变化更准确和客观地与 CRN 相关，为烟草在 CRN 发展中的作用提供了更清晰的证据。
