吸菸對前列腺癌整體與癌症特異性死亡率的影響：年長與早期病患風險升高

林仁傑¹、何宗翰²、曾文歆^1,3、劉建良¹、黃冠華¹、邱文祥⁴

¹奇美醫學中心 外科部 泌尿科；
²奇美醫學中心 醫學研究部；
³國立中山大學 生物醫學科學研究所；
⁴台北新光吳火獅紀念醫院 泌尿部

Impact of Smoking on Overall and Cancer-Specific Mortality in Prostate Cancer: Elevated Risks in Older and Early-Stage Patients – A Population-Based Study

Jen-Chieh Lin¹、Chung-Han Ho²、Wen-Hsin Tseng^1,3、Chien-Liang Liu¹、Steven K. Huang¹、Allen W.Chiu⁴

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan;
³Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

⁴Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

Purpose: In Taiwan, prostate cancer ranks sixth among the causes of cancer mortality. Moreover, despite the enactment of the Tobacco Hazards Prevention Act in 2009, smoking prevalence remains high among men. This study utilizes Taiwan's National Health Insurance Research Database to assess the impact of smoking on the mortality of prostate cancer, aiming to provide targeted insights for healthcare strategies and patient management.

Materials and Methods: After an exclusion process, 23,107 prostate cancer patients were finally included from an initial dataset from 2011 to 2017. After allocating patients into smokers (n= 7,164) and non-smokers (n= 15,943), the study examined baseline characteristics, clinical stages, comorbidities, treatment modalities, and survival outcomes including overall and cancer-specific mortality. The analysis involved Cox regression and subgroup assessments stratified by clinical stage and age groups.

Results: In age group stratification, smoking significantly increased mortality in patients older than 60-year-old. Furthermore, smokers exhibited higher risks of overall mortality across all clinical stages. The association with prostate cancer-specific mortality was significantly higher in early-stage PCa after stratification (adjusted hazard ratio of 1.35 (95% CI: 1.06-1.71), p = 0.0139). In Kaplan-Meier analysis, smokers demonstrated poorer overall survival and prostate cancer-specific mortality after a seven-year follow-up (p < 0.0001).

Conclusion: Our study demonstrated an association between smoking and increased overall mortality in PCa patients over 60-year-old. Furthermore, in early-stage PCa, smoking was associated with increased prostate cancer-specific mortality. Other identified risk factors include a Charlson comorbidity index > 3, hyperlipidemia, and a BMI > 25. Active management of smoking, comorbidities, and obesity is crucial for clinical urologists in treating prostate cancer, particularly for those in early stage.