摘要：据6月22/29日刊《美国医学会杂志》上的一则研究披露，那些被诊断患有前列腺癌而且同时也是吸烟的人，其相关的全因、心血管性及前列腺癌特异性死亡风险会增加。这些病人前列腺癌的复发可能性也会增加。
不断增长的证据提示，吸烟可能会增加侵袭型前列腺癌的罹患风险及前列腺癌的死亡率。然而，根据文章的背景资料，吸烟与前列腺癌死亡率或复发率的关系的研究是有限的，前列腺癌特异性的结果也很少。
波士顿哈佛公共卫生学院的Stacey A. Kenfield, Sc.D.及其同事开展了一项研究，旨在评估吸烟或停止吸烟与总体死亡率、前列腺癌特异性死亡率、心血管疾病（CVD）死亡率及前列腺癌患者中的生化指标的复发之间的关系。该项研究包括在1986-2006年期间在医疗专业人员跟踪研究中的5366名被诊断患有前列腺癌的男子。
在被诊断罹患前列腺癌的男子中，有1632人死亡，其中524人（占32%）因前列腺癌而死，有416人（占26%）因CVD而死，有878人出现生化指标的复发。分析表明，与从来不吸烟者相比，目前的吸烟者的前列腺癌、CVD及全因死亡率的风险会增加，他们发生生化指标复发的风险也会增加。吸烟年数和每日吸烟包数越大，其前列腺癌死亡率、CVD死亡率及全因死亡率的风险也相应越大，但它们与前列腺癌的生化指标的复发则没有相关性。与目前的吸烟者相比，那些戒烟时间达10年或以上者的前列腺癌死亡风险与那些从来不吸烟者的死亡风险类似。
文章的作者写道，吸烟对前列腺癌的发展具有直接的影响在生物学上似乎是可能的，这包括来自烟草的致癌物质对肿瘤的促进作用；血浆睾酮的总浓度和游离浓度的增加（睾酮是一种在某些吸烟者中与前列腺癌的发生和发展有关的雄性激素，而有些研究报告两者之间存在着一种剂量依赖性的关系）；后生效应（包括在目前吸烟者中的与疾病的侵袭性具有相关性的异常甲基化谱）以及烟碱诱发的血管生成（新血管的形成）、毛细血管生长以及肿瘤的生长和增生。
文章的作者得出结论：“总之，在疾病诊断时，吸烟与总体死亡率和前列腺癌死亡率及复发的大幅增加之间有关系。戒烟达10年者的风险与从来不吸烟者的风险相似。这些结果为吸烟可能增加前列腺癌的死亡风险提供了进一步的支持。”
吸烟可能会增加侵袭型前列腺癌的罹患风险及前列腺癌的死亡率
生物探索推荐英文原文报道：
Being a smoker at time of prostate cancer diagnosis linked with increased risk of death
CHICAGO – Men who are diagnosed with prostate cancer and who are also smokers have an associated increased risk of all-cause, cardiovascular and prostate cancer-specific death, according to a study in the June 22/29 issue of JAMA. These patients also had an increased likelihood of prostate cancer recurrence.
Accumulating evidence suggests that smoking may increase risk of aggressive prostate cancer and prostate cancer mortality. However, studies of smoking in relation to prostate cancer mortality or recurrence in prostate cancer patients are limited, with few prostate cancer-specific outcomes, according to background information in the article.
Stacey A. Kenfield, Sc.D., of the Harvard School of Public Health, Boston, and colleagues conducted a study 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. The study included 5,366 men diagnosed with prostate cancer between 1986 and 2006 in the Health Professionals Follow-Up Study.
Among the men diagnosed with prostate cancer, there were 1,630 deaths, 524 (32 percent) due to prostate cancer and 416 (26 percent) to CVD, and 878 biochemical recurrences. Analysis indicated that compared with never smokers, current smokers had an increased risk of dying from prostate cancer, CVD, and all-cause mortality and an increased risk of biochemical recurrence. A greater number of pack-years was associated with an increased risk of prostate cancer mortality, CVD mortality, and total mortality but not biochemical recurrence. Compared with current smokers, men who had quit smoking for 10 or more years had prostate cancer mortality risks similar to those who had never smoked.
The authors write that a direct effect of smoking on prostate cancer progression is biologically plausible, including tumor promotion through carcinogens from tobacco smoke; increased plasma levels of total and free testosterone, an androgen involved in the development and progression of prostate cancer in some smokers, with some studies reporting a dose-dependent association; epigenetic effects, including aberrant methylation profiles among current smokers, which correlate with aggressive disease; and nicotine-induced angiogenesis [formation of new blood vessels], capillary growth, and tumor growth and proliferation.
“In summary, smoking at the time of diagnosis was associated with substantially increased overall mortality and prostate cancer mortality and recurrence. Ten-year quitters had risks similar to never smokers. These results provide further support that smoking may increase risk of death from prostate cancer,” the authors conclude.
生物探索推荐英文论文摘要：
Smoking and Prostate Cancer Survival and Recurrence
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: cardiovascular diseases, mortality, neoplasm recurrence, local, prostatic neoplasms, risk factors, smoking, smoking cessation, survival.
