Effects of smoking and drinking status before operation on recurrence and metastasis of esophageal squamous cell carcinoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHU Jianfei ¹ , DOU Yawei ¹ , TIAN Wei ¹ , DAI Yun ¹ , LUO Xianghui ¹ , CHEN Yaohua ¹ , WANG Hongtao ¹ ,  LI Zhe ²

1. Department of Thoracic Surgery, Shannxi Provincial People's Hospital, Xi'an, 710068, P.R.China;
2. Department of Hematology and Oncology, Yan’an People’s Hospital, Yan’an, 716000, Shanxi, P.R.China;

Corresponding author：

LI Zhe, Email: shuangjixiu@126.com

Keywords：

Smoking status; drinking status; esophageal squamous cell cancer; prognosis; surgery

DOI：

10.7507/1007-4848.202004047

Video：

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Objective To evaluate the effect of smoking and drinking status on the prognosis of patients with esophageal squamous cell carcinoma (ESCC).Methods The clinical data of 483 patients with ESCC who underwent surgical treatment in Shannxi Provincial People's Hospital from 2007 to 2016 were retrospectively analyzed. Among them, 352 patients were male and 131 were female, with a median age of 64 (37-80) years. There were 311 smokers and 172 drinkers. The relationship between preoperative drinking or smoking status and the clinicopathological characteristics of patients with ESCC was analyzed. Log-rank method and Cox risk regression were used to conduct univariate and multivariate survival analysis, respectively.Results The preoperative smoking status was related to the patient's tumor location (P=0.030). Drinking status was associated with tumor location (P=0.001), degree of differentiation (P=0.030), pathological T stage (P=0.024) and pathological N stage (P=0.029). Univariate survival analysis showed that smoking status did not affect the disease-free survival (DFS) (P=0.188) and overall survival (OS) (P=0.127) of patients with ESCC. However, patients who drank alcohol had worse PFS than non-drinking patients (29.37 months vs. 42.87 months, P=0.009). It was further proved that alcohol consumption was an independent risk factor affecting patients' recurrence and metastasis by using multivariate analysis (RR=1.28, P=0.040). Alcohol consumption also reduced the OS of patients by 21.47 months (P=0.014), however, multivariate analysis did not yield significant results.Conclusion Preoperative drinking status is related to the stage and differentiation of patients with ESCC. It is an independent risk factor affecting the recurrence and metastasis of ESCC.

Citation： ZHU Jianfei, DOU Yawei, TIAN Wei, DAI Yun, LUO Xianghui, CHEN Yaohua, WANG Hongtao, LI Zhe. Effects of smoking and drinking status before operation on recurrence and metastasis of esophageal squamous cell carcinoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(2): 219-224. doi: 10.7507/1007-4848.202004047 Copy

1.	Danaei G, Vander HS, Lopez AD, et al. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet, 2005, 366(9499): 1784-1793.
2.	Mayne ST, Risch HA, Dubrow R, et al. Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev, 2001, 10(10): 1055-1062.
3.	Cheng TD, Darke AK, Redman MW, et al. Smoking, sex, and non-small cell lung cancer: steroid hormone receptors in tumor tissue (S0424). J Natl Cancer Inst, 2018, 110(7): 734-742.
4.	Löfling L, Karimi A, Sandin F, et al. Clinical characteristics and survival in non-small cell lung cancer patients by smoking history: a population-based cohort study. Acta Oncol, 2019, 58(11): 1618-1627.
5.	Lubin JH, Cook MB, Pandeya N, et al. The importance of exposure rate on odds ratios by cigarette smoking and alcohol consumption for esophageal adenocarcinoma and squamous cell carcinoma in the Barrett's esophagus and esophageal adenocarcinoma consortium. Cancer Epidemiol, 2012, 36(3): 306-316.
6.	Freedman ND, Abnet CC, Leitzmann MF, et al. A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes. Am J Epidemiol, 2007, 165(12): 1424-1433.
7.	Chen J, Zhang N, Ling Y, et al. Alcohol consumption as a risk factor for esophageal adenocarcinoma in north China. Tohoku J Exp Med, 2011, 224(1): 21-27.
8.	Gammon MD, Schoenberg JB, Ahsan H, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst, 1997, 89(17): 1277-1284.
9.	Lin Y, Su X, Su H, et al. Prediagnostic smoking and postoperative survival in lymph node-negative esophagus squamous cell carcinoma patients. Cancer Sci, 2012, 103(11): 1985-1988.
10.	Zhang F, Han H, Wang C, et al. A retrospective study: the prognostic value of anemia, smoking and drinking in esophageal squamous cell carcinoma with primary radiotherapy. World J Surg Oncol, 2013, 11: 249.
11.	Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol, 2010, 17(7): 1721-1724.
12.	Yang HX, Hou X, Liu QW, et al. Tumor location does not impact long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China. Ann Thorac Surg, 2012, 93(6): 1861-1866.
13.	Situ D, Wei W, Lin P, et al. Do tumor grade and location affect survival in esophageal squamous cell carcinoma? Survival analysis of 302 cases of pT3N0M0 esophageal squamous cell carcinoma. Ann Surg Oncol, 2013, 20(2): 580-585.
14.	Hou X, Gu YK, Liu XW, et al. The impact of tumor cell differentiation on survival of patients with resectable esophageal squamous cell carcinomas. Ann Surg Oncol, 2015, 22(3): 1008-1014.
15.	Huang Q, Luo K, Yang H, et al. Impact of alcohol consumption on survival in patients with esophageal carcinoma: a large cohort with long-term follow-up. Cancer Sci, 2014, 105(12): 1638-1646.
16.	Biramijamal F, Allameh A, Mirbod P, et al. Unusual profile and high prevalence of p53 mutations in esophageal squamous cell carcinomas from northern Iran. Cancer Res, 2001, 61(7): 3119-3123.
17.	Taghavi N, Biramijamal F, Sotoudeh M, et al. Association of p53/p21 expression with cigarette smoking and prognosis in esophageal squamous cell carcinoma patients. World J Gastroenterol, 2010, 16(39): 4958-4967.
18.	Dura P, Berkers T, van Veen EM, et al. Polymorphisms in alcohol-metabolizing enzymes and esophageal carcinoma susceptibility: a Dutch Caucasian case-control study. J Hum Genet, 2013, 58(11): 742-748.

1. Danaei G, Vander HS, Lopez AD, et al. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet, 2005, 366(9499): 1784-1793.
2. Mayne ST, Risch HA, Dubrow R, et al. Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev, 2001, 10(10): 1055-1062.
3. Cheng TD, Darke AK, Redman MW, et al. Smoking, sex, and non-small cell lung cancer: steroid hormone receptors in tumor tissue (S0424). J Natl Cancer Inst, 2018, 110(7): 734-742.
4. Löfling L, Karimi A, Sandin F, et al. Clinical characteristics and survival in non-small cell lung cancer patients by smoking history: a population-based cohort study. Acta Oncol, 2019, 58(11): 1618-1627.
5. Lubin JH, Cook MB, Pandeya N, et al. The importance of exposure rate on odds ratios by cigarette smoking and alcohol consumption for esophageal adenocarcinoma and squamous cell carcinoma in the Barrett's esophagus and esophageal adenocarcinoma consortium. Cancer Epidemiol, 2012, 36(3): 306-316.
6. Freedman ND, Abnet CC, Leitzmann MF, et al. A prospective study of tobacco, alcohol, and the risk of esophageal and gastric cancer subtypes. Am J Epidemiol, 2007, 165(12): 1424-1433.
7. Chen J, Zhang N, Ling Y, et al. Alcohol consumption as a risk factor for esophageal adenocarcinoma in north China. Tohoku J Exp Med, 2011, 224(1): 21-27.
8. Gammon MD, Schoenberg JB, Ahsan H, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst, 1997, 89(17): 1277-1284.
9. Lin Y, Su X, Su H, et al. Prediagnostic smoking and postoperative survival in lymph node-negative esophagus squamous cell carcinoma patients. Cancer Sci, 2012, 103(11): 1985-1988.
10. Zhang F, Han H, Wang C, et al. A retrospective study: the prognostic value of anemia, smoking and drinking in esophageal squamous cell carcinoma with primary radiotherapy. World J Surg Oncol, 2013, 11: 249.
11. Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol, 2010, 17(7): 1721-1724.
12. Yang HX, Hou X, Liu QW, et al. Tumor location does not impact long-term survival in patients with operable thoracic esophageal squamous cell carcinoma in China. Ann Thorac Surg, 2012, 93(6): 1861-1866.
13. Situ D, Wei W, Lin P, et al. Do tumor grade and location affect survival in esophageal squamous cell carcinoma? Survival analysis of 302 cases of pT3N0M0 esophageal squamous cell carcinoma. Ann Surg Oncol, 2013, 20(2): 580-585.
14. Hou X, Gu YK, Liu XW, et al. The impact of tumor cell differentiation on survival of patients with resectable esophageal squamous cell carcinomas. Ann Surg Oncol, 2015, 22(3): 1008-1014.
15. Huang Q, Luo K, Yang H, et al. Impact of alcohol consumption on survival in patients with esophageal carcinoma: a large cohort with long-term follow-up. Cancer Sci, 2014, 105(12): 1638-1646.
16. Biramijamal F, Allameh A, Mirbod P, et al. Unusual profile and high prevalence of p53 mutations in esophageal squamous cell carcinomas from northern Iran. Cancer Res, 2001, 61(7): 3119-3123.
17. Taghavi N, Biramijamal F, Sotoudeh M, et al. Association of p53/p21 expression with cigarette smoking and prognosis in esophageal squamous cell carcinoma patients. World J Gastroenterol, 2010, 16(39): 4958-4967.
18. Dura P, Berkers T, van Veen EM, et al. Polymorphisms in alcohol-metabolizing enzymes and esophageal carcinoma susceptibility: a Dutch Caucasian case-control study. J Hum Genet, 2013, 58(11): 742-748.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effects of smoking and drinking status before operation on recurrence and metastasis of esophageal squamous cell carcinoma

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