Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
Department of Kinesiology, Faculty of Health and Human Sciences, University of North Carolina Greensboro, Greensboro, NC, USA.
Cancer Causes Control. 2024 Jan;35(1):121-132. doi: 10.1007/s10552-023-01777-w. Epub 2023 Aug 19.
To examine the independent and joint relationships between cigarette smoking and alcohol consumption with survival outcomes after endometrial cancer diagnosis.
Pre- and post-diagnosis smoking and drinking histories were obtained from endometrial cancer survivors diagnosed between 2002 and 2006 during in-person interviews at-diagnosis and at ~ 3 years post-diagnosis. Participants were followed until death or January 2022. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards regression for associations with disease-free survival (DFS) and overall survival (OS).
During a median 16.9 years of follow-up (IQR = 15.5-18.1 years), 152 of the 540 participants had a DFS event (recurrence: n = 73; deaths: n = 79) and 134 died overall. Most participants in this cohort were current drinkers (pre = 61.3%; post = 64.7%) while few were current cigarette smokers (pre = 12.8%; post = 11.5%). Pre-diagnosis alcohol consumption was not associated with survival, yet post-diagnosis alcohol intake ≥ 2 drinks/week was associated with worse OS compared with lifetime abstention (HR = 2.36, 95%CI = 1.00-5.54) as well as light intake (HR = 3.87, 95% CI = 1.67-8.96). Increased/consistently high alcohol intake patterns were associated with worse OS (HR = 2.91, 95% CI = 1.15-7.37) compared with patterns of decreased/ceased intake patterns after diagnosis. A harmful dose-response relationship per each additional pre-diagnosis smoking pack-year with OS was noted among ever smokers. In this cohort, smoking and alcohol individually were not associated with DFS and combined pre-diagnosis smoking and alcohol intakes were not associated with either outcome.
Endometrial cancer survivors with higher alcohol intakes after diagnosis had poorer OS compared with women who had limited exposure. Larger studies powered to investigate the individual and joint impacts of cigarette smoking and alcohol use patterns are warranted to provide additional clarity on these modifiable prognostic factors.
研究子宫内膜癌诊断后吸烟和饮酒与生存结果之间的独立和联合关系。
通过面对面访谈，在 2002 年至 2006 年间诊断出的子宫内膜癌幸存者在诊断时和诊断后约 3 年获得了诊断前和诊断后吸烟和饮酒史。参与者的随访时间截止至死亡或 2022 年 1 月。采用 Cox 比例风险回归估计多变量调整后的风险比（HR）和 95%置信区间（CI），以评估与无病生存（DFS）和总生存（OS）的相关性。
在中位 16.9 年的随访期间（IQR=15.5-18.1 年），540 名参与者中有 152 名发生 DFS 事件（复发：n=73；死亡：n=79），134 名参与者死亡。在本队列中，大多数参与者为当前饮酒者（诊断前=61.3%；诊断后=64.7%），而很少有当前吸烟者（诊断前=12.8%；诊断后=11.5%）。诊断前的饮酒与生存无关，但与终生戒酒相比，诊断后每周饮酒≥2 杯与较差的 OS 相关（HR=2.36，95%CI=1.00-5.54），与轻度饮酒（HR=3.87，95%CI=1.67-8.96）相关。与诊断后减少/停止饮酒模式相比，增加/持续高饮酒模式与较差的 OS 相关（HR=2.91，95%CI=1.15-7.37）。在曾经吸烟者中，每增加一个诊断前吸烟包年数与 OS 呈有害的剂量反应关系。在本队列中，吸烟和饮酒单独与 DFS 无关，而诊断前的吸烟和饮酒联合与两种结局均无关。
与暴露程度有限的女性相比，诊断后饮酒量较高的子宫内膜癌幸存者的 OS 较差。需要更大规模的研究来调查吸烟和饮酒模式的个体和联合影响，以提供这些可改变的预后因素的额外明确信息。
