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. 2018 Feb 1;29(2):472-483.
doi: 10.1093/annonc/mdx761.

Impact of Prediagnostic Smoking and Smoking Cessation on Colorectal Cancer Prognosis: A Meta-Analysis of Individual Patient Data From Cohorts Within the CHANCES Consortium

Free PMC article

Impact of Prediagnostic Smoking and Smoking Cessation on Colorectal Cancer Prognosis: A Meta-Analysis of Individual Patient Data From Cohorts Within the CHANCES Consortium

J M Ordóñez-Mena et al. Ann Oncol. .
Free PMC article


Background: Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies and might also be associated with prognosis after CRC diagnosis. However, current evidence on smoking in association with CRC prognosis is limited.

Patients and methods: For this individual patient data meta-analysis, sociodemographic and smoking behavior information of 12 414 incident CRC patients (median age at diagnosis: 64.3 years), recruited within 14 prospective cohort studies among previously cancer-free adults, was collected at baseline and harmonized across studies. Vital status and causes of death were collected for a mean follow-up time of 5.1 years following cancer diagnosis. Associations of smoking behavior with overall and CRC-specific survival were evaluated using Cox regression and standard meta-analysis methodology.

Results: A total of 5229 participants died, 3194 from CRC. Cox regression revealed significant associations between former [hazard ratio (HR) = 1.12; 95 % confidence interval (CI) = 1.04-1.20] and current smoking (HR = 1.29; 95% CI = 1.04-1.60) and poorer overall survival compared with never smoking. Compared with current smoking, smoking cessation was associated with improved overall (HR<10 years = 0.78; 95% CI = 0.69-0.88; HR≥10 years = 0.78; 95% CI = 0.63-0.97) and CRC-specific survival (HR≥10 years = 0.76; 95% CI = 0.67-0.85).

Conclusion: In this large meta-analysis including primary data of incident CRC patients from 14 prospective cohort studies on the association between smoking and CRC prognosis, former and current smoking were associated with poorer CRC prognosis compared with never smoking. Smoking cessation was associated with improved survival when compared with current smokers. Future studies should further quantify the benefits of nonsmoking, both for cancer prevention and for improving survival among CRC patients, in particular also in terms of treatment response.


Figure 1.
Figure 1.
Forest plots for the association between former and current smoking (reference: never smoking) and overall and CRC-specific survival. Abbreviations: HR, hazard ratio; CI, confidence interval; CRC, colorectal cancer. Abbreviated study names: COSM, Cohort of Swedish Men; DK, Denmark; EPIC, European Prospective Investigation into Cancer and Nutrition; ES, Spain; ESTHER, Early Recognition and Optimized Treatment of Chronic Diseases in the Older Population; GR, Greece; MORGAM, Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) Risk, Genetics, Archiving and Monograph; MORGAM FI, Finrisk Study (Finland); MORGAM NI, PRIME Belfast Study (Northern Ireland); MORGAM SE, Northern Sweden MONICA examinations (Norrbotten county only); NIH-AARP, National Institute of Health—American Association of Retired Persons; NL, The Netherlands; RS, Rotterdam Study; SMC, Swedish Mammography Cohort; TROMSØ, The Tromsø Study; VIP, Västerbotten Intervention Programme. 1HRs and 95% CIs were adjusted for sex, age, BMI, education, alcohol intake, tumor site, diabetes and vigorous physical activity; estimates from COSM, EPIC-DK/-ES/-GR, ESTHER, NIH-AARP and SMC were additionally adjusted for tumor stage; adjustment for vigorous physical activity was not possible for MORGAM FI and SE; adjustment for diabetes was not possible in MORGAM FI.

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