From the Department of Gastroenterology, Ruijin Hospital.
Department of Oncology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pancreas. 2019 Sep;48(8):985-995. doi: 10.1097/MPA.0000000000001383.
Current evidence on cigarette smoking associated with pancreatic cancer mortality is limited. We searched MEDLINE, Web of Science, and Embase databases to identify relevant studies published through January 31, 2018. A random-effects model was used to estimate summary hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 20 studies were retrieved, involving 2,517,623 participants. Of these, more than 15,341 patients with pancreatic cancer died. Compared with never smokers, current (summary HR, 1.56; 95% CI, 1.34-1.83) and former (summary HR, 1.15; 95% CI, 1.06-1.26) smokers had elevated risk of total mortality in patients diagnosed with pancreatic cancer. This effect of cigarette smoking is observed both in the Western regions and the Asia-Pacific regions. This effect of smoking is independent of alcohol use, body mass index, and history of diabetes but is modified by tumor stage and study settings. Dose-response associations between smoking and pancreatic cancer mortality were revealed for smoking intensity, cumulative amount of cigarettes smoked, and duration of smoking. Cigarette smoking was associated with an increase in total mortality for patients with pancreatic cancer. Future studies should further clarify the role of smoking as an effect modifier in treatment trials of pancreatic cancer.
目前有关吸烟与胰腺癌死亡率关系的证据有限。我们检索了 MEDLINE、Web of Science 和 Embase 数据库，以确定截至 2018 年 1 月 31 日发表的相关研究。采用随机效应模型来估计汇总风险比（HR）和 95％置信区间（CI）。共检索到 20 项研究，涉及 2517623 名参与者。其中，超过 15341 名胰腺癌患者死亡。与从不吸烟者相比，当前吸烟者（汇总 HR，1.56；95％CI，1.34-1.83）和曾经吸烟者（汇总 HR，1.15；95％CI，1.06-1.26）罹患胰腺癌后的总死亡率升高。在西方和亚太地区均观察到吸烟对总死亡率的这种影响。这种吸烟的作用独立于饮酒、体重指数和糖尿病史，但受肿瘤分期和研究设置的影响。吸烟与胰腺癌死亡率之间的剂量反应关系显示，吸烟强度、吸烟总量和吸烟时间与胰腺癌死亡率呈正相关。吸烟与胰腺癌患者的总死亡率增加有关。未来的研究应进一步阐明吸烟作为胰腺癌治疗试验中的一个效应修饰因子的作用。
