吸烟与结肠直肠癌的发病率和死亡率：系统回顾与荟萃分析
2010/01/05
目的：综合现有数据，对目前的前瞻性研究进行综合荟萃分析，进研究吸烟与结肠直肠癌之间的关联。
方法：对36个研究进行了荟萃分析，分析吸烟与结肠直肠癌（CRC）、结肠癌、直肠癌的发病率和死亡率的关联。对吸烟状况、每天烟草消耗量、吸烟时间、包-年数和开始吸烟的年龄。
结果：相对于非吸烟者，现在和既往的吸烟者的结肠直肠癌发病率和死亡率有着显著增高的风险。联合分析结肠直肠癌的数据与结肠癌/直肠癌的数据，现时吸烟者的结肠直肠癌发病率的风险显著增高。共有4个剂量-反应变量与结肠直肠癌的发病率显著相关（所有的P值均< 0.0001），包括 检测到的每天烟草消耗( 增加到40支烟 /天时的 风险比RR = 1.38), 吸烟时间(增加到40年时的RR = 1.20 ), 包-年数(增加到60包-年时的RR = 1.51) ，开始吸烟的年龄 (开始吸烟的年龄延迟10年的RR = 0.96)。吸烟时间与直肠癌发病率的相关关系同样是显著的。
结论：通过现有的前瞻性研究的分析得到了吸烟与结肠直肠癌之间的一致性的关联。通过亚组分析发现吸烟与直肠癌的关联显得比与结肠癌的关系更加密切。
（张永明编译 刘国梁审校）
Int J Cancer.2008 Nov 26. [Epub ahead of print]
Cigarette smoking and colorectal cancer incidence and mortality: Systematic review and meta-analysis.
Harvard School of Public Health, Boston, MA.
The association between cigarette smoking and colorectal cancer (CRC) has been controversial. To synthesize the available data, we conducted a comprehensive meta-analysis of all prospective studies. A total of 36 studies were included in our meta-analysis. We examined the association between smoking and CRC, colon cancer and rectal cancer in terms of incidence and mortality. Separate analyses were conducted for smoking status, daily cigarette consumption, duration, pack-years and age of initiation. Relative to nonsmokers, current and former smokers had a significantly increased risk of CRC incidence and mortality, respectively. When CRC data were combined with colon/rectal cancer data, current smokers had a significantly increased risk of CRC incidence. All 4 dose-response variables examined-daily cigarette consumption (RR = 1.38 for an increase of 40 cigarettes/day), duration (RR = 1.20 for an increase of 40 years of duration), pack-years (RR = 1.51 for an increase of 60 pack-years) and age of initiation (RR = 0.96 for a delay of 10 years in smoking initiation)-were significantly associated with CRC incidence (all p-values < 0.0001). The relationship between duration of smoking and rectal cancer incidence was also significant. Among the subset of studies that distinguished cancer by site, a higher risk was seen for rectal cancer than for colon cancer for all analyses. Among prospective studies, a consistent association exists between smoking and CRC. The association is stronger for rectal cancer than for colon cancer in the subset of studies that differentiated cancer by site. (c) 2008 Wiley-Liss, Inc.
PMID: 19142968 [PubMed - as supplied by publisher]
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