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目的对诊断为原发性肺肿瘤后戒烟对预后的影响证据进行系统性研究。设计用荟萃分析做系统性回顾。数据源CINAHL(从1981),Embase(从1980),Medline(从1966),Web of Science(从1966),CENTRAL(从1977)至2008年12月,所含的研究见列单。研究选择所包括的研究包括,随机对照试验或观察纵向研究,且这些研究测量了诊断肺癌后戒烟对预后的作用,忽视目前所处期和肿瘤史。数据提取2名研究者对研究所含数据进行鉴别和提取。采用随机效应模式结合评估,12统计学值用于检测异质。用生命表塑造早期非小细胞肺癌和局限期小细胞癌5年幸存率,本研究利用了获得的继续吸烟者和戒烟者的死亡率。结果所含研究的9/10,大多数病人诊断为早期肺肿瘤。继续吸烟明显增加了全因死亡风险[危害比2.94,95%CI为(1.15,7.54)],早期非小细胞肺癌再发[1.86,(1.01,3.41)],全因死亡[1.86,(1.33,2.59)],发现第二原发肿瘤[4.31,(1.09,16.98)],局限期小细胞肺癌再发[1.26,(1.06,1.50)]。尚无研究特定数据表明戒烟对癌症死亡率或非小细胞肺癌发生第二原发肿瘤的作用。生命表模型法对这些数据的评价表明,早期非小细胞肺癌65岁病人5年幸存率,继续吸烟者为33%,而戒烟者为70%。基于本研究数据,局限期小细胞肺癌5年幸存率,继续吸烟者为29%,而戒烟者为63%。结论本研究为诊断早期肺癌后戒烟可改善预后结果提供了初步证据。生命表模型法,戒烟后防止死亡数目比因心肺死亡减少所期待数目要大,因而,大多数死亡率增益更可能是减慢癌症的进展。这些发现说明,对现存早期肺癌病人提出戒烟治疗是有益的。
Objective To systematically investigate the evidence of the influence of smoking cessation on prognosis after diagnosis of primary lung cancer. Design a meta-analysis to do a systematic review. Data sources CINAHL (from 1981), Embase (from 1980), Medline (from 1966), Web of Science (from 1966), CENTRAL (from 1977) to December 2008, are included in the list. Studies included in the study include randomized controlled trials or longitudinal studies, and these studies measure the effect of smoking cessation on prognosis after diagnosis of lung cancer, ignoring the current period and history of cancer. Data extraction Two researchers identified and extracted the data contained in the study. Using a combination of random effects model evaluation, 12 statistical tests were used to detect heterogeneity. Using the life table to create a 5-year survival rate for early-stage non-small cell lung cancer and localized small cell cancer, this study used the mortality rates obtained for continuing smokers and ex-smokers. Results included 9/10 of the study, most of the patients diagnosed as early lung tumors. Continued smoking significantly increased the risk of all-cause mortality (hazard ratio 2.94, 95% CI 1.15, 7.54), early recurrence of non-small cell lung cancer 1.86 (1.01,3.41), all-cause death 1.86 , 2.59)], a second primary tumor was found [4.31, (1.09, 16.98)], and limited-stage small cell lung cancer recurrence [1.26, (1.06, 1.50)]. No specific data have been shown to indicate the effect of quitting smoking on cancer mortality or second primary tumor development in non-small cell lung cancer. Evaluation of these data by the life table model showed that the 5-year survivorship of patients with early-stage non-small cell lung cancer at 65 years of age was 33% for those who continued to smoke and 70% for those who quit smoking. Based on our data, the 5-year survivorship of SCLC was 29% for those who continued to smoke and 63% for those who quit smoking. Conclusion This study provides preliminary evidence for the diagnosis of early lung cancer after smoking cessation can improve prognosis. The life table model approach, the number of preventable deaths after quitting smoking is larger than the expected number of deaths due to cardiopulmonary deaths, so most of the gains in mortality are more likely to slow the progression of cancer. These findings suggest that smoking cessation therapy may be beneficial to existing early-stage lung cancer patients.