重度吸烟对术前放化疗直肠癌患者预后的影响  

Effect of heavy smoking on prognosis of patients received concurrent chemoradiotherapy followed by total mesorectal excision

作　　者：张锦亮 王辉云[2] 徐国良[3] 杨箐[3] 林世永[3] 单宏波[3] 

机构地区：[1]深圳市龙华新区中心医院肿瘤科,广东深圳518110 [2]中山大学肿瘤防治中心.华南肿瘤学国家重点实验室实验研究部,广东广州510060 [3]中山大学肿瘤防治中心.华南肿瘤学国家重点实验室内镜激光科,广东广州510060

出　　处：《中华肿瘤防治杂志》2015年第2期95-99,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的探讨重度吸烟是否影响接受新辅助同期放化疗并手术的直肠癌患者的生存。方法回顾性收集中山大学肿瘤防治中心2008-07-01-2011-06-30所有接受三维适形放射治疗（three dimensional conformal radiotherapy,3D-CRT）的患者资料,患者入组标准为：放射总剂量46Gy/23次,同期XELOX（奥沙利铂＋卡培他滨）方案化疗2个周期,随后行直肠癌根治术。根据吸烟指数（包/d×年数）将符合入组标准的125例患者分为重度吸烟组（≥20包年）83例和非重度吸烟组（〈20包年）42例。统计分析重度吸烟与直肠癌放化疗疗效、复发、转移和预后的关系。结果重度吸烟组与非重度吸烟组在放化疗疗效方面差异无统计学意义,χ^2=0.11,P=0.739;局部复发和远处转移的发生则差异有统计学意义,χ^2=0.35,P=0.037。Logistic多因素分析结果显示,重度吸烟是复发的独立影响因素,Wald=5.00,P=0.026。非重度吸烟患者的无瘤生存期和总体生存期明显好于重度吸烟患者,χ2分别为4.719和5.729,P值分别为0.030和0.017。Cox多因素回归分析结果显示,重度吸烟是影响患者无瘤生存期（Wald=6.20,RR=3.52,95%CI为1.31～9.47,P=0.013）和总生存期（Wald=5.21,RR=3.18,95%CI为1.17～8.58,P=0.023）的独立风险因素。结论患者治疗前的吸烟情况与直肠癌的同期放化疗疗效无相关性,而与患者治疗后的生存及肿瘤复发转移明显相关。OBJECTIVE To investigate the inftuances of cigarette smoking on survival of rectal cancer patients re- ceived neoadjuvant concurrent chemoradiotherapy followed radical surgery. METHODS Medical data of 125 consecutive rectal cancer patients who received the same regimen of neoadjuvant concurrent chemoradiotherapy followed by radical surgery in our hospital were collected between July 1, 2008 and June 30,2011. Three dimensional conformal radiotherapy （3D-CRT） was delivered in a total dose of 46 Gy （23 fractions in 5 weeks） ,and the concurrent chemotherapy regimen was XELOX （Oxaliplatin＋Capecitabine）. Patients were separated into heavy smokers （≥20 pack-years, 83 cases） and non- heavy smokers （〈20 pack-years, 42 cases） according to the smoking index,which was defined as the product of the num- ber of packs consumed per day and years of smoking. Influences of cigarette smoking on neoadjuvant chemoradiotherapy efficacy,tumor recurrence and prognosis were analyzed. RESULTS The efficacy of chemoradiotherapy between heavy smokers and non-heavy smoker was not significantly different （x2= 0.11,P= 0. 739）, while recurrence between the two groups was significantly different （X2= 4.35,P= 0. 037）. Binary Logistic analysis showed that heavy smokers were inde- pendent factors of recurrence （Wald =5.00, P = 0. 026）. The disease-free survival and overall survival of patientswith non-heavy smoking were significantly better than those with heavy smoking （X2 value was 4. 719 and 5. 729, respectively;P value was 0. 030 and 0. 017,respectively）. Multivariate Cox regression model analysis showed that heavy smoking was an independent risk factor for disease-free survival （Wald=6.20; RR=3.52,95 % CI：1. 31--9. 47; P=0. 013） and overall survival （Wald=5.21; RR=3.18,95%CI：1.17--8.58; P=0.023）. CONCLUSIONS Cigarette smoking has no effect on efficacy of concurrent chemoradiotherapy for rectal cancer,while smoking is significantly correlated with tumor recur rence and survival of patients wi

关 键 词：吸烟 直肠癌 新辅助同期放化疗 预后 

分 类 号：R735.37[医药卫生—肿瘤]