Doeun Jang1,2, Sunho Choe1, Ji Won Park2,3, Seung-Yong Jeong2,3, Aesun Shin1,2. 1. Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea. 2. Cancer Research Institute, Seoul National University, Seoul, Korea. 3. Division of Colorectal Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Smoking is a well-known risk factor for colorectal cancer incidence; however, the effect of smoking before and after cancer diagnosis on mortality has not been addressed well. Thus, we aimed to evaluate the association of prediagnosis and postdiagnosis smoking status and mortality among colorectal cancer patients. METHODS: A retrospective cohort consisted of 37,079 male colorectal cancer patients. Smoking status was defined from information within 2 years of colorectal cancer diagnosis for prediagnosis and at least 1 year later for postdiagnosis. The prediagnostic and postdiagnostic smoking status were categorized into four groups (nonsmoker/nonsmoker, nonsmoker/smoker, smoker/nonsmoker, and smoker/smoker). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazard model. RESULTS: During a median of 6.3 years of follow-up, a total of 3980 deaths and 2137 deaths from colorectal cancer occurred. The number of prediagnosis smokers were 11,100 and 62.4% of them quitted smoking after the diagnosis. Significantly elevated mortality rate in prediagnosis smokers was observed regardless of postdiagnosis smoking status (smoker/nonsmoker [HR, 1.30; 95% CI, 1.20-1.41] and smoker/smoker [HR, 1.21; 95% CI, 1.09-1.34]). Among patients treated with surgical operation only, those who quit smoking after diagnosis showed lower mortality rates compared to continual smokers (HR, 0.80; 95% CI, 0.67-0.96). CONCLUSIONS: Smoking before cancer diagnosis rather than postdiagnosis has stronger impact on prognosis colorectal cancer patients, and quitting smoking may improve survival, especially among early stage colorectal cancer patients.
BACKGROUND: Smoking is a well-known risk factor for colorectal cancer incidence; however, the effect of smoking before and after cancer diagnosis on mortality has not been addressed well. Thus, we aimed to evaluate the association of prediagnosis and postdiagnosis smoking status and mortality among colorectal cancerpatients. METHODS: A retrospective cohort consisted of 37,079 male colorectal cancerpatients. Smoking status was defined from information within 2 years of colorectal cancer diagnosis for prediagnosis and at least 1 year later for postdiagnosis. The prediagnostic and postdiagnostic smoking status were categorized into four groups (nonsmoker/nonsmoker, nonsmoker/smoker, smoker/nonsmoker, and smoker/smoker). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazard model. RESULTS: During a median of 6.3 years of follow-up, a total of 3980 deaths and 2137 deaths from colorectal cancer occurred. The number of prediagnosis smokers were 11,100 and 62.4% of them quitted smoking after the diagnosis. Significantly elevated mortality rate in prediagnosis smokers was observed regardless of postdiagnosis smoking status (smoker/nonsmoker [HR, 1.30; 95% CI, 1.20-1.41] and smoker/smoker [HR, 1.21; 95% CI, 1.09-1.34]). Among patients treated with surgical operation only, those who quit smoking after diagnosis showed lower mortality rates compared to continual smokers (HR, 0.80; 95% CI, 0.67-0.96). CONCLUSIONS: Smoking before cancer diagnosis rather than postdiagnosis has stronger impact on prognosis colorectal cancerpatients, and quitting smoking may improve survival, especially among early stage colorectal cancerpatients.
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