Smoking Behavior and Prognosis After Colorectal Cancer Diagnosis: A Pooled Analysis of 11 Studies-Reference-Cited by-同舟云学术

Smoking Behavior and Prognosis After Colorectal Cancer Diagnosis: A Pooled Analysis of 11 Studies

Published:2021-08-31 Issue:5 Volume:5 Page:
ISSN:2515-5091
Container-title:JNCI Cancer Spectrum
language:en
Short-container-title:

Author:

Alwers Elizabeth¹^ORCID,Carr Prudence R¹,Banbury Barbara²,Walter Viola¹,Chang-Claude Jenny³⁴^ORCID,Jansen Lina¹^ORCID,Drew David A⁵⁶^ORCID,Giovannucci Edward⁷⁸⁹^ORCID,Nan Hongmei¹⁰,Berndt Sonja I¹¹,Huang Wen-Yi¹¹^ORCID,Prizment Anna¹²^ORCID,Hayes Richard B¹³^ORCID,Sakoda Lori C¹⁴,White Emily²,Labadie Julia²¹⁵^ORCID,Slattery Martha¹⁶,Schoen Robert E¹⁷^ORCID,Diergaarde Brenda¹⁸¹⁹,van Guelpen Bethany²⁰²¹^ORCID,Campbell Peter T²²^ORCID,Peters Ulrike²¹⁵,Chan Andrew T⁵⁶⁷²³,Newcomb Polly A²,Hoffmeister Michael¹^ORCID,Brenner Hermann¹²⁴²⁵^ORCID

Affiliation:

1. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

2. Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

3. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

4. Genetic Tumor Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg, Germany

5. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

6. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

7. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

8. Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA

9. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

10. Department of Global Health, Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA

11. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

12. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA

13. Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, NY, USA

14. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

15. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA

16. Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

17. Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

18. Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, PA, USA

19. UPMC Hillman Cancer Center, Pittsburgh, PA, USA

20. Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden

21. Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden

22. Department of Population Science, American Cancer Society, Atlanta, GA, USA

23. Broad Institute of Harvard and MIT, Cambridge, MA, USA

24. Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany

25. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany

Abstract

Abstract Background Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies, but current evidence on smoking in association with survival after CRC diagnosis is limited. Methods We pooled data from 12 345 patients with stage I-IV CRC from 11 epidemiologic studies in the International Survival Analysis in Colorectal Cancer Consortium. Cox proportional hazards regression models were used to evaluate the associations of prediagnostic smoking behavior with overall, CRC-specific, and non-CRC-specific survival. Results Among 12 345 patients with CRC, 4379 (35.5%) died (2515 from CRC) over a median follow-up time of 7.5 years. Smoking was strongly associated with worse survival in stage I-III patients, whereas no association was observed among stage IV patients. Among stage I-III patients, clear dose-response relationships with all survival outcomes were seen for current smokers. For example, current smokers with 40 or more pack-years had statistically significantly worse overall, CRC-specific, and non-CRC-specific survival compared with never smokers (hazard ratio [HR] =1.94, 95% confidence interval [CI] =1.68 to 2.25; HR = 1.41, 95% CI = 1.12 to 1.78; and HR = 2.67, 95% CI = 2.19 to 3.26, respectively). Similar associations with all survival outcomes were observed for former smokers who had quit for less than 10 years, but only a weak association with non-CRC-specific survival was seen among former smokers who had quit for more than 10 years. Conclusions This large consortium of CRC patient studies provides compelling evidence that smoking is strongly associated with worse survival of stage I-III CRC patients in a clear dose-response manner. The detrimental effect of smoking was primarily related to noncolorectal cancer events, but current heavy smoking also showed an association with CRC-specific survival.

Funder

ISACC: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

GECCO: National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services

National Cancer Institute (NCI) of the National Institutes of Health

Deutsche Forschungsgemeinschaft

German Federal Ministry of Education and Research

DALS: National Institutes of Health

NCI, EDRN

National Institutes of Health

NSHDS: Swedish Research Council

Swedish Cancer Society

Region Västerbotten