Summary: | Introduction
This study aimed to evaluate the association between smoking and
smoking index with clinical outcomes of esophageal squamous cell carcinoma
patients.
Methods
This is a retrospective analysis conducted on consecutive patients
with esophageal carcinoma who underwent esophagectomy from January
2005 to December 2010. All patients had pathologically confirmed
esophageal squamous cell carcinoma. The association between smoking
and sociodemographic characteristics with overall survival and disease-free
survival was analyzed. Serum carcinoembryonic antigen was measured using
an electrochemiluminescence immunoassay.
Results
A total of 944 patients were enrolled. Kaplan–Meier analysis indicated
that esophageal squamous cell carcinoma patients who smoked had a
significantly worse prognosis in terms of both overall survival (p=0.007) and
disease-free survival (p= 0.010). Multivariate analysis demonstrated that age
(p=0.001), carcinoembryonic antigen (p=0.012), tumor-node-metastasis
(TNM) staging (p<0.001) and smoking (p=0.048) were independently
correlated with overall survival, while only TNM stage (p<0.001) and smoking
(p=0.041) were identified as independent factors of disease-free survival.
We divided the smoking population into two groups (smoking index <400
and ≥400). Kaplan–Meier survival analysis indicated that a smoking index
<400 was associated with a significantly better prognosis in terms of both
overall survival (p=0.003) and favorable disease-free survival (p=0.032).
Multivariate analysis showed that age (p<0.001), TNM staging (p<0.001),
and smoking index (p=0.025) were independent factors of overall survival,
whereas for disease-free survival, only TNM stage (p=0.001) and smoking
index (p=0.025) were identified.
Conclusions
Overall survival was significantly associated with smoking in
esophageal squamous cell carcinoma patients. For esophageal squamous cell
carcinoma patients who smoke, a higher smoking index is associated with
worse clinical outcomes. Therefore, smoking may be used as a predictive
indicator for pretreatment evaluation and adjustment of treatment regimen.
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