Jochems Sylvia H J, Fritz Josef, Häggström Christel, Järvholm Bengt, Stattin Pär, Stocks Tanja
Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
Eur Urol. 2023 May;83(5):422-431. doi: 10.1016/j.eururo.2022.03.033. Epub 2022 May 4.
Prospective and detailed investigations of smoking and prostate cancer (PCa) risk and death are lacking.
To investigate prediagnosis smoking habit (status, intensity, duration, and cessation) as a risk factor, on its own and combined with body mass index (BMI), for PCa incidence and death.
DESIGN, SETTING, AND PARTICIPANTS: We included 351448 men with smoking information from five Swedish cohorts.
We used Cox regression to calculate hazard ratios (HRs) and confidence intervals (CIs) for PCa incidence (n = 24731) and death (n = 4322).
Smoking was associated with a lower risk of any PCa (HR 0.89, 95% CI 0.86-0.92), which was most pronounced for low-risk PCa (HR 0.74, 95% CI 0.69-0.79) and was restricted to PCa cases diagnosed in the prostate-specific antigen (PSA) era. Smoking was associated with a higher risk of PCa death in the full cohort (HR 1.10, 95% CI 1.02-1.18) and in case-only analysis adjusted for clinical characteristics (HR 1.20, 95% CI 1.11-1.31), which was a consistent finding across case groups (p = 0.8 for heterogeneity). Associations by smoking intensity and, to lesser degree, smoking duration and cessation, supported the associations for smoking status. Smoking in combination with obesity (BMI ≥30 kg/m) further decreased the risk of low-risk PCa incidence (HR 0.40, 95% CI 0.30-0.53 compared to never smokers with BMI <25 kg/m) and further increased the risk of PCa death (HR 1.49, 95% CI 1.21-1.84). A limitation of the study is that only a subgroup of men had information on smoking habit around the time of their PCa diagnosis.
The lower PCa risk for smokers in the PSA era, particularly for low-risk PCa, can probably be attributed to low uptake of PSA testing by smokers. Poor survival for smokers, particularly obese smokers, requires further study to clarify the underlying causes and the preventive potential of smoking intervention for PCa death.
Smokers have a higher risk of dying from prostate cancer, which further increases with obesity.
目前缺乏对吸烟与前列腺癌（PCa）风险及死亡情况的前瞻性详细调查。
研究诊断前吸烟习惯（状态、强度、持续时间和戒烟情况）作为独立的风险因素，以及与体重指数（BMI）相结合，对PCa发病率和死亡率的影响。
设计、设置和参与者：我们纳入了来自瑞典五个队列的351448名有吸烟信息的男性。
我们使用Cox回归计算PCa发病率（n = 24731）和死亡率（n = 4322）的风险比（HRs）和置信区间（CIs）。
吸烟与任何PCa的较低风险相关（HR 0.89，95% CI 0.86 - 0.92），这在低风险PCa中最为明显（HR 0.74，95% CI 0.69 - 0.79），且仅限于在前列腺特异性抗原（PSA）时代诊断出的PCa病例。在整个队列中，吸烟与PCa死亡的较高风险相关（HR 1.10，95% CI 1.02 - 1.18），在针对临床特征进行调整的仅病例分析中也是如此（HR 1.20，95% CI 1.11 - 1.31），这在各病例组中是一致的发现（异质性p = 0.8）。吸烟强度以及在较小程度上吸烟持续时间和戒烟情况的关联支持了吸烟状态的关联。吸烟与肥胖（BMI≥30 kg/m²）相结合进一步降低了低风险PCa发病率的风险（与BMI < 25 kg/m²的从不吸烟者相比，HR 0.40，95% CI 0.30 - 0.53），并进一步增加了PCa死亡的风险（HR 1.49，95% CI 1.21 - 1.84）。该研究的一个局限性是只有一部分男性在PCa诊断时附近有吸烟习惯的信息。
在PSA时代吸烟者PCa风险较低，尤其是低风险PCa，这可能归因于吸烟者对PSA检测的接受度低。吸烟者，尤其是肥胖吸烟者的不良生存率，需要进一步研究以阐明潜在原因以及吸烟干预对PCa死亡的预防潜力。
吸烟者死于前列腺癌的风险更高，肥胖会进一步增加这种风险。
