Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada.
Med Oncol. 2018 Apr 11;35(5):68. doi: 10.1007/s12032-018-1129-0.
To assess the impact of smoking history on the outcomes of early-stage breast cancer patients treated with sequential anthracyclines-taxanes in a randomized study. This is a secondary analysis of patient-level data of 1242 breast cancer patients referred for adjuvant chemotherapy in the BCIRG005 clinical trial. Overall survival was assessed according to smoking history through Kaplan-Meier analysis. Univariate and multivariate Cox regression analyses of factors affecting overall and relapse-free survival were subsequently conducted. Factors that were evaluated included: age, performance status, number of chemotherapy cycles, T stage, lymph node ratio, estrogen receptor status, adjuvant radiotherapy and smoking history. Kaplan-Meier analysis of overall survival according to smoking status (ever smoker vs. never smoker) was conducted. There was a trend toward a better overall survival among never smokers compared to ever smokers; however, it was not statistically significant (P = 0.098). The following factors were associated with better overall survival in multivariate analysis: older age (P = 0.011), complete chemotherapy course (P = 0.002), lower T stage (P < 0.0001), lower lymph node ratio (P < 0.0001) and positive estrogen receptor status (P = 0.006). Otherwise, the following factors were associated with better relapse-free survival in multivariate analysis: older age (P = 0.001), never smoking status (P = 0.021), lower T stage (P = 0.028), lower lymph node ratio (P < 0.0001) and positive estrogen receptor status (P < 0.0001). Early-stage breast cancer patients with a positive smoking history experienced worse relapse-free survival compared to never smokers. Physicians managing breast cancer patients should prioritize discussion about the benefits of smoking cessation when counseling their patients.
为了评估吸烟史对接受序贯蒽环类药物-紫杉类药物辅助化疗的早期乳腺癌患者结局的影响，本研究对 BCIRG005 临床试验中 1242 例辅助化疗乳腺癌患者的个体水平数据进行了二次分析。通过 Kaplan-Meier 分析评估了吸烟史对总生存的影响。随后对影响总生存和无复发生存的因素进行了单因素和多因素 Cox 回归分析。评估的因素包括：年龄、体能状态、化疗周期数、T 分期、淋巴结比值、雌激素受体状态、辅助放疗和吸烟史。根据吸烟状态（既往吸烟者与从不吸烟者）进行了总生存的 Kaplan-Meier 分析。从不吸烟者的总生存趋势优于既往吸烟者，但无统计学意义（P=0.098）。多因素分析显示，以下因素与总生存较好相关：年龄较大（P=0.011）、完成全程化疗（P=0.002）、T 分期较低（P<0.0001）、淋巴结比值较低（P<0.0001）和雌激素受体阳性（P=0.006）。相反，多因素分析显示，以下因素与无复发生存较好相关：年龄较大（P=0.001）、从不吸烟状态（P=0.021）、T 分期较低（P=0.028）、淋巴结比值较低（P<0.0001）和雌激素受体阳性（P<0.0001）。早期乳腺癌患者中，有吸烟史者的无复发生存较从不吸烟者差。管理乳腺癌患者的医生在为患者提供咨询时，应优先讨论戒烟的益处。
