吸烟与前列腺癌：前瞻性队列研究的系统评价与荟萃分析
Cigarette smoking and prostate cancer: A systematic review and meta-analysis of prospective cohort studies.
作者信息
Al-Fayez Sarah, El-Metwally Ashraf
机构信息
College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
出版信息
Tob Induc Dis. 2023 Feb 6;21:19. doi: 10.18332/tid/157231. eCollection 2023.
INTRODUCTION
Cigarette smoking is a well-known cancer-causing behavior and a leading cause of death from cancer. However, according to previously published research and meta-analyses, cigarette smoking has a significant inverse association with prostate cancer incidence. Therefore, this study aims to investigate this association based on updated evidence by conducting a systematic review and meta-analysis.
METHODS
A search for relevant articles was performed in PubMed and Scopus databases to obtain the pooled relative risk (RR) and the corresponding 95% confidence intervals (CIs) for the risk of prostate cancer incidence among smokers compared to non-smokers. Our search was limited to prospective cohort studies.
RESULTS
A total of 17 cohort studies were included in the systematic review. Fifteen studies were included in the meta-analysis and showed that cigarette smoking has an inverse association with prostate cancer incidence with a relative risk of 0.84 (95% CI: 0.78-0.91). From all cohorts included in this systematic review, five studies examined the association between current smokers and the risk of death from prostate cancer. Therefore, a meta-analysis of these cohort studies was performed and showed that current smokers had a 42% higher risk of death from prostate cancer when compared to non-smokers with a relative risk of 1.42 (95% CI: 1.20-1.68).
CONCLUSIONS
Data from observational studies suggest that cigarette smoking has an inverse association with prostate cancer incidence. However, smokers have an increased risk of death from prostate cancer. Important to realize that this lower risk for smokers might be attributed to low prostate cancer screening uptake among smokers, misclassification bias, or selection bias from the included original studies. In summary, our results indicate that the incidence of prostate cancer is lower among smokers. Nevertheless, smokers who develop the disease have a significantly worse prognosis.
引言
吸烟是一种众所周知的致癌行为，也是癌症死亡的主要原因。然而，根据先前发表的研究和荟萃分析，吸烟与前列腺癌发病率呈显著负相关。因此，本研究旨在通过进行系统评价和荟萃分析，基于最新证据调查这种关联。
方法
在PubMed和Scopus数据库中检索相关文章，以获得吸烟者与非吸烟者相比前列腺癌发病风险的合并相对风险（RR）及相应的95%置信区间（CI）。我们的检索仅限于前瞻性队列研究。
结果
系统评价共纳入17项队列研究。荟萃分析纳入了15项研究，结果显示吸烟与前列腺癌发病率呈负相关，相对风险为0.84（95%CI：0.78 - 0.91）。在本系统评价纳入的所有队列中，有5项研究考察了当前吸烟者与前列腺癌死亡风险之间的关联。因此，对这些队列研究进行了荟萃分析，结果显示与非吸烟者相比，当前吸烟者死于前列腺癌的风险高42%，相对风险为1.42（95%CI：1.20 - 1.68）。
结论
观察性研究数据表明，吸烟与前列腺癌发病率呈负相关。然而，吸烟者死于前列腺癌的风险增加。需要认识到，吸烟者风险较低可能归因于吸烟者前列腺癌筛查率低、错误分类偏倚或纳入的原始研究中的选择偏倚。总之，我们的结果表明吸烟者中前列腺癌发病率较低。然而，患该病的吸烟者预后明显更差。
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