Prediagnostic Smoking and Alcohol Drinking and Gastric Cancer Survival: A Korean Prospective Cohort Study

Shin Ah Kim; Bo Youl Choi; Kyu Sang Song; Chan Hyuk Park; Chang Soo Eun; Dong Soo Han; Yong Sung Kim; Hyun Ja Kim

doi:10.4166/kjg.2019.73.3.141

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Kim, Choi, Song, Park, Eun, Han, Kim, and Kim: Prediagnostic Smoking and Alcohol Drinking and Gastric Cancer Survival: A Korean Prospective Cohort Study

Original Article

Alimentary Tract

The Korean Journal of Gastroenterology 2019; 73(3): 141-151.

Published online: 27 March 2019

DOI: https://doi.org/10.4166/kjg.2019.73.3.141

Prediagnostic Smoking and Alcohol Drinking and Gastric Cancer Survival: A Korean Prospective Cohort Study

Shin Ah Kim, Bo Youl Choi¹, Kyu Sang Song², Chan Hyuk Park^3,⁴, Chang Soo Eun^3,⁴, Dong Soo Han^3,⁴, Yong Sung Kim⁵, Hyun Ja Kim

Department of Food and Nutrition, Gangneung-Wonju National University College of Life Science, Gangneung, Korea.

¹Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea.

²Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea.

³Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

⁴Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.

⁵Genome Editing Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Korea.

Correspondence to: Hyun Ja Kim, Department of Food and Nutrition, Gangneung-Wonju National University College of Life Science, 7 Jukheon-gil, Gangneung 25457, Korea. Tel: +82-33-640-2967, Fax: +82-33-640-2330, wisekim@gwnu.ac.kr

Received 23 October 2018 Revised 20 December 2018 Accepted 2 January 2019

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Behavioral factors, such as smoking and heavy alcohol consumption, increase the risk of gastric cancer (GC), but their effects on survival are not clear. We examined associations between prediagnostic smoking and alcohol drinking behavior and GC death by long-term follow-up.

Methods

The participants were 508 GC patients enrolled at Chungnam University Hospital and Hanyang University Guri Hospital from 2001 to 2006. Information on clinicopathologic and behavioral risk factors was collected, and patient survival was prospectively followed until 2016 by medical chart review and telephone survey.

Results

During above 10 years follow-up period, overall death was 46.2% (n=226) and GC deaths was 38.2% (n=187) among the 489 GC patients included in the analysis. No significant association was found between smoking habits and overall or GC survival. However, after stratification by histological type, the hazard ratio (HR) of GC death for current smokers tended to be higher for the diffuse type (HR 1.61, 95% CI 0.57–4.59 for current vs. never) rather than for the intestinal type (HR 0.78, 95% CI 0.28–2.19 for current vs. never). Light alcohol consumption was found to be associated with a significantly lower risk of GC death (HR 0.52, 95% CI 0.36–0.75 for <20 g/day for women or <40 g/day for men vs. never and past), and the effects of alcohol drinking habits had similar effects on GC death for the intestinal and diffuse types.

Conclusions

These results suggest smoking and alcohol drinking behaviors before a diagnosis of GC are weakly associated with GC survival. Nevertheless, the effect of smoking behavior on prognosis appears to depend on the histological type of GC.

Keywords: Stomach neoplasms, Survival, Smoking, Drinking, Prospective studies

Figures and Tables

Fig. 1

Gastric cancer specific survival curves of patients according to smoking and drinking behaviors. (A) Smoking status. (B) Pack-year. (C) Drinking status. (D) Alcohol consumption (g/day).

Table 1

Observed Overall and Gastric Cancer Specific Survivals in Gastric Cancer Patients with respect to General and Clinicopathological Characteristics

Values are presented as n (%).

GC, gastric cancer.

^aThe final observation end-point was in 31 Dec 2016; ^bFamily history of GC included first and second-degree relatives; ^cIt was impossible to collect the tissue; ^dClassification by 8th edition of Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) staging system for gastric cancer.

Table 2

Observed Overall and Gastric Cancer Specific Survivals in Gastric Cancer Patients with respect to Smoking and Alcohol Drinking

Values are presented as n (%).

Numbers may not sum to total due to missing information.

GC, gastric cancer; WHO, World Health Organization.

^aThe final observation end-point was in 31 Dec 2016; ^bThis daily alcohol consumption was annual average intake for 3 years ago; ^cThis category were divided according to WHO's recommendation (2004).

Table 3

Adjusted Hazard Ratios and 95% Confidence Intervals for Overall and Gastric Cancer Specific Death with Respect to Smoking and Alcohol Drinking Behaviors

Numbers may not sum to total due to missing information.

GC, gastric cancer; HR, hazard ratio; CI, confidence interval; NA, not applicable; WHO, World Health Organization.

^aAdjusted for age (continuous), sex (women/men), registered hospital (Chungnam University/Hanyang University Guri), family history of gastric cancer (included first and second-degree relatives, no/yes), smoking and drinking status (never/past/current), Helicobacter pylori infection (negative/positive/not performed), surgery (no/yes), adjuvant chemotherapy (no/yes), stage (I/II/III/IV/unknown), and histological type (intestinal/diffuse and mixed/unknown); bThis daily alcohol consumption was annual average intake for 3 years ago; cThis category were divided according to WHO's recommendation (2004).

Table 4

Adjusted Hazard Ratios and 95% Confidence Intervals for Gastric Cancer Specific Death with Respect to Smoking and Alcohol Drinking Behaviors Stratified by Histological Type

Numbers may not sum to total due to missing information.

GC, gastric cancer; HR, hazard ratio; CI, confidence interval; NA, not applicable; WHO, World Health Organization.

^aAdjusted for age (continuous), sex (women/men), registered hospital (Chungnam University/Hanyang University Guri), family history of gastric cancer (included first and second-degree relatives, no/yes), smoking and drinking status (never/past/current), Helicobacter pylori infection (negative/positive/not performed), surgery (no/yes), adjuvant chemotherapy (no/yes), and stage (I/II/III/IV/unknown); ^bThis daily alcohol consumption was annual average intake for 3 years ago; ^cThis category were divided according to WHO's recommendation (2004).

Notes

^{Financial support} This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (grant number: 2017R1D1A3B03032996).

^{Conflict of interest} None.

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ORCID iDs: Hyun Ja Kim
https://orcid.org/0000-0002-0965-9704
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