1986-2006年に前立腺癌と診断された男性医療従事者5366人を対象に、喫煙と死亡率および生化学的再発の関係を観察研究で検討。診断時点での喫煙者は、全死亡率、心血管死亡率、前立腺癌特異的死亡率、再発率がいずれも高かった。10年以上禁煙している人の前立腺癌特異的死亡リスクは、喫煙経験のない人と同程度だった。

Smoking and Prostate Cancer Survival and Recurrence
1.. Stacey A. Kenfield, ScD;
2.. Meir J. Stampfer, MD, DrPH;
3.. June M. Chan, ScD;
4.. Edward Giovannucci, MD, ScD
[+] Author Affiliations

1.. Author Affiliations: Departments of Epidemiology (Drs Kenfield, Stampfer, and Giovannucci) and Nutrition (Drs Stampfer and Giovannucci), Harvard School of Public Health, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (Drs Kenfield, Stampfer, and Giovannucci), Boston, Massachusetts; and Departments of Epidemiology & Biostatistics and Urology, University of California, San Francisco (Dr Chan).

Abstract

Context Studies of smoking in relation to prostate cancer mortality or recurrence in prostate cancer patients are limited, with few prostate cancer?specific outcomes.

Objective To assess the relation of cigarette smoking and smoking cessation with overall, prostate cancer?specific, and cardiovascular disease (CVD) mortality and biochemical recurrence among men with prostate cancer.

Design, Setting, and Participants Prospective observational study of 5366 men diagnosed with prostate cancer between 1986 and 2006 in the Health Professionals Follow-Up Study.

Main Outcome Measures Hazard ratios (HRs) for overall, prostate cancer?specific, and CVD mortality, and biochemical recurrence, defined by an increase in prostate-specific antigen (PSA) levels.

Results There were 1630 deaths, 524 (32%) due to prostate cancer and 416 (26%) to CVD, and 878 biochemical recurrences. Absolute crude rates for prostate cancer?specific death for never vs current smokers were 9.6 vs 15.3 per 1000 person-years; for all-cause mortality, the corresponding rates were 27.3 and 53.0 per 1000 person-years. In multivariable analysis, current vs never smokers had an increased risk of prostate cancer mortality (HR, 1.61; 95% confidence interval [CI], 1.11-2.32), as did current smokers with clinical stage T1 through T3 (HR, 1.80; 95% CI, 1.04-3.12). Current smokers also had increased risk of biochemical recurrence (HR, 1.61; 95% CI, 1.16-2.22), total mortality (HR, 2.28; 95% CI, 1.87-2.80), and CVD mortality (HR, 2.13; 95% CI, 1.39-3.26). After adjusting for clinical stage and grade (likely intermediates of the relation of smoking with prostate cancer recurrence and survival), current smokers had increased risk of prostate cancer mortality (HR, 1.38; 95% CI, 0.94-2.03), as did current smokers with clinical stage T1 through T3 (HR, 1.41; 95% CI, 0.80-2.49); they also had an increased risk of biochemical recurrence (HR, 1.47; 95% CI, 1.06-2.04). Greater number of pack-years was associated with significantly increased risk of prostate cancer mortality but not biochemical recurrence. Current smokers of 40 or more pack-years vs never smokers had increased prostate cancer mortality (HR, 1.82; 95% CI, 1.03-3.20) and biochemical recurrence (HR, 1.48; 95% CI, 0.88-2.48). Compared with current smokers, those who had quit smoking for 10 or more years (HR, 0.60; 95% CI, 0.42-0.87) or who have quit for less than 10 years but smoked less than 20 pack-years (HR, 0.64; 95% CI, 0.28-1.45) had prostate cancer mortality risks similar to never smokers (HR, 0.61; 95% CI, 0.42-0.88).

Conclusions Smoking at the time of prostate cancer diagnosis is associated with increased overall and CVD mortality and prostate cancer?specific mortality and recurrence. Men who have quit for at least 10 years have prostate cancer?specific mortality risks similar to those who have never smoked.

KEYWORDS:
a.. CARDIOVASCULAR DISEASES,
b.. MORTALITY,
c.. NEOPLASM RECURRENCE, LOCAL,
d.. PROSTATIC NEOPLASMS,
e.. RISK FACTORS,
f.. SMOKING,
g.. SMOKING CESSATION,
h.. SURVIVAL