吸烟对接受（放）化疗的肛门癌患者预后的影响。
Impact of tobacco smoking on the patient's outcome after (chemo)radiotherapy for anal cancer.
机构信息
Saint-Louis Hospital, Radiation Oncology, AP-HP. Nord, Paris, France.
Diaconesses-Croix Saint Simon Hospital, Proctology, Paris, France.
出版信息
Eur J Cancer. 2020 Dec;141:143-151. doi: 10.1016/j.ejca.2020.09.039. Epub 2020 Nov 1.
PURPOSE
Anal squamous cell carcinoma is associated with multiple risk factors, including infection with human papillomavirus and human immunodeficiency virus, immunosuppression, multiple sex partners, receptive anal sex and tobacco smoking. The aim of our study was to identify prognostic factors associated with poor outcomes after radiotherapy for anal cancer.
METHODS
We analysed retrospectively the medical records of 171 patients treated by (chemo)radiotherapy for non-metastatic anal cancer in our institution from 2000 to 2015. Patients and tumour characteristics, treatments (chemotherapy, radiotherapy [RT] and surgery) and outcomes were reported. Colostomy-free survival (CRF), disease-free survival and overall survival (OS) at 5 years were studied. Univariate and multivariate analyses were performed by logistic regression to determine factors associated with poor progression-free survival (PFS).
RESULTS
Patients' characteristics were as follows: median age, 62 years (range = 36-89); gender, 45 men (26%) and 126 women (74%); HIV serology, positive: 21 patients (12%); tobacco smoking, 86 patients (50%), among whom 28 patients and 58 patients were current and former smokers, respectively. Tumours were classified as locally limited (T1-2, N0, M0) for 86 patients (50%) and locally advanced (T3-4 or N+, M0) for 85 patients (50%). The median total dose was 64.4 Gy (range = 54-76.6), and 146 patients were treated by concurrent chemoradiotherapy. Factors associated with poor PFS in univariate analysis were as follows: tumour size >4 cm, lymph node involvement, tobacco smoking, no initial surgical excision and anal warts at diagnosis. In multivariate analysis, only tobacco smoking status was significantly associated with poor PFS (hazard ratio = 2.85, 95% confidence interval [1.25-6.50], p = 0.013). Five-year PFS for non-smokers, former smokers and current smokers was 88.1%, 76.7% and 73.8%, respectively (p = 0.038). Tobacco smoking was also associated with poor overall survival (p = 0.03), locoregional relapse-free survival (LRFS; p = 0.05) and CFS (p = 0.02).
CONCLUSIONS
Tobacco smoking status is associated with poor OS, LRFS, PFS and CFS in patients treated for anal cancer by high RT dose ± chemotherapy.
目的
分析鳞状细胞癌与多种危险因素相关，包括人乳头瘤病毒和人类免疫缺陷病毒感染、免疫抑制、多个性伴侣、接受性肛交和吸烟。本研究的目的是确定与肛门癌放疗后不良结局相关的预后因素。
方法
我们回顾性分析了 2000 年至 2015 年间在我们机构接受（放）化疗治疗非转移性肛门癌的 171 例患者的病历。报告了患者和肿瘤特征、治疗（化疗、放疗[RT]和手术）和结局。研究了 5 年无结直肠造口术生存率（CRF）、无疾病生存率和总生存率（OS）。通过 logistic 回归进行单因素和多因素分析，以确定与不良无进展生存率（PFS）相关的因素。
结果
患者的特征如下：中位年龄 62 岁（范围 36-89 岁）；性别，45 名男性（26%）和 126 名女性（74%）；HIV 血清学，阳性：21 名患者（12%）；吸烟，86 名患者（50%），其中 28 名和 58 名患者分别为当前吸烟者和既往吸烟者。肿瘤分为局限性（T1-2、N0、M0）86 例（50%）和局部进展（T3-4 或 N+、M0）85 例（50%）。中位总剂量为 64.4Gy（范围 54-76.6Gy），146 例患者接受同期放化疗。单因素分析中与不良 PFS 相关的因素如下：肿瘤大小>4cm、淋巴结受累、吸烟、无初始手术切除和诊断时存在肛门疣。多因素分析中，只有吸烟状态与不良 PFS 显著相关（风险比=2.85，95%置信区间[1.25-6.50]，p=0.013）。非吸烟者、前吸烟者和当前吸烟者的 5 年 PFS 分别为 88.1%、76.7%和 73.8%（p=0.038）。吸烟也与总生存（p=0.03）、局部无复发生存率（LRFS；p=0.05）和 CFS（p=0.02）不良相关。
结论
在接受高剂量 RT±化疗治疗肛门癌的患者中，吸烟状态与 OS、LRFS、PFS 和 CFS 不良相关。
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