Prediagnostic smoking and postoperative survival in lymph node‐negative esophagus squamous cell carcinoma patients

Abstract

Smoking is well known as a risk factor for esophageal cancer, but controversial as a prognostic factor. Moreover, evidence is scarce that a dose-response relationship exists. We conducted a retrospective study on the effect and dose-response relationship of prediagnostic smoking on the postoperative disease-specific survival of patients with lymph node-negative esophageal squamous cell carcinoma (ESCC). We enrolled 643 patients with lymph node-negative ESCC who had undergone esophagectomy between 1990 and 2005 at the Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China. The patients' demographic, pathological, preoperative and cancer outcome data were obtained from medical records. These data were reviewed and analyzed using life table, Kaplan-Meier analysis and multivariate Cox regression. A significant reduction in 3-and 5-year survival rates was observed in smokers with lymph node-negative ESCC compared with those in non-smokers. The 3-and 5-year survival rates were 54% and 46% for smokers, and 67% and 64% for non-drinkers, respectively (P < 0.05). Multivariate Cox analysis revealed that smoking was an independent prognostic factor (P = 0.008, hazard ratio = 1.404). Both log-rank test (P = 0.065) and multivariate analysis (P = 0.091) showed no significant difference between the survival rates of light and heavy smokers. Prediagnostic smoking is an independent prognostic factor for patients with lymph node-negative ESCC, but the dose-response relationship needs further investigation. (Cancer Sci 2012; 103: 1985-1988 E sophageal cancer is the sixth leading cause of cancer mortality worldwide.(1) According to the most recent global estimates, esophagus cancer causes 407 000 deaths annually. (2) In China, it is the fifth most common and fourth most lethal malignant tumor, and squamous cell carcinoma prevails in terms of histology.(3) Despite advances in early diagnosis and surgical treatments, overall prognosis is poor with the 5-year survival rate rarely >20%. It is well known that smoking is damaging public health on a global scale by playing an important role in the development of lung, head, neck and esophageal cancers. Well-conducted population-based studies have reported a significantly increased risk of esophageal squamous cell carcinoma (ESCC) associated with smoking, regardless of dosage.(8-10) However, the correlation between smoking and patient survival is less investigated and more controversial. Some studies reported that smokers had a worse prognosis, (11,12) while others denied the correlation.(13) The present study aimed to determine whether prediagnostic smoking has an independent influence on disease-specific survival (DSS) in patients with lymph node-negative ESCC, and whether a dose-dependent relationship exists. Materials and MethodsWe conducted a large-scale retrospective study by searching the esophageal cancer database of the Department of Thoracic Surgery at Sun Yat-sen University Cancer Center, Guangzhou, China. In total, 643 patients with lymph node-neg...

Younger women have a better prognosis among patients with esophageal squamous cell carcinoma after esophagectomy

“…Smoking and alcohol drinking were found to be negative prognostic factors in univariate analysis, but they did not have significant influence on survival in multivariate analysis. Prediagnostic smoking has been reported as an independent prognostic factor for patients with ESCC (21). The impact of alcohol consumption on survival in patients with ESCC was demonstrated by two large cohort studies (22,23).…”

Value and application of trimodality therapy or definitive concurrent chemoradiotherapy in thoracic esophageal squamous cell carcinoma

“…in that smoking might alter the behavior of a tumor and promote its progression. [48][49][50] By contrast, the use of surgery alone, trimodality therapy, or definitive CCRT causes side effects in cardiopulmonary functions. However, evidence for prediagnosed alcohol consumption as a prognostic factor in patients with ESCC is insufficient.…”

“…[45][46][47] Our results are also compatible with those from previous studies. [48][49][50] By contrast, the use of surgery alone, trimodality therapy, or definitive CCRT causes side effects in cardiopulmonary functions. [51][52][53] Patients with ESCC who have alcohol consumption and cigarettes smoking habits may have poor cardiopulmonary function and, accordingly, cannot tolerate aggressive treatments, resulting in more complications with similar treatments.…”

Protein kinase D1 mRNA level may predict cancer-specific survival in heavy smokers with esophageal squamous cell cancers

“…Smoking is well known in damaging public health on a global scale by playing an important role in the development of many cancers . Well‐conducted population‐based studies have reported that cigarette smoking would significantly increase the risk of esophageal cancer, and it also associated with worse outcomes . However, the specific molecular targets affected by cigarette‐derived carcinogens have not been thoroughly identified.…”