Pretreatment Lifestyle Behaviors as Survival Predictors for Patients with Nasopharyngeal Carcinoma

BackgroundLifestyle behaviors have been widely reported to influence the survival of patients with head and neck cancer. However, the relationship between pretreatment lifestyle behaviors and survival among patients with nasopharyngeal carcinoma (NPC) is unclear. MethodsA prospective cohort study was designed to determine the relationship between lifestyle behaviors and survival in 1,533 NPC patients recruited from October 2005 to October 2007. Pretreatment lifestyle behaviors (such as body-mass index [BMI], smoking, alcohol, diet) of the patients were investigated. Univariate and multivariate proportional-hazards models were used to assess the impact of lifestyle behaviors on patient survival. ResultsSmoking was a predictor of survival; both current smokers (hazard ratio [HR] = 1.88; 95% CI, 1.33 to 2.65) and heavy smokers (≥25 Pack-years; HR = 1.84; 95% CI, 1.30 to 2.60) showed associations with poor survival. Higher BMI was significantly associated with a lower risk of death (Ptrend = 0.002). Compared with under/normal-weight patients (BMI less than 22.99 kg/m2), the multivariate HR for survival was 0.66 (95% CI, 0.48 to 0.90) and 0.47 (95% CI, 0.23 to 0.97) for overweight and obese patients, respectively. No alcohol intake and high fruit intake were associated with favorable survival in the univariate analysis but lost significance in the multivariate model. ConclusionOur findings indicate that pretreatment lifestyle behaviors, especially smoking status and BMI, as easily available data, provide prognostic value for survival in NPC patients.背景 已有大量研究证实，生活方式行为会对头颈癌患者的生存结局产生影响。然而，鼻咽癌（nasopharyngeal carcinoma, NPC）患者治疗前的生活方式行为与其生存预后之间的关联尚不明确。 方法 本研究设计为一项前瞻性队列研究，旨在明确2005年10月至2007年10月期间招募的1533例鼻咽癌患者的生活方式行为与其生存结局之间的关联。研究人员对患者治疗前的生活方式行为（包括体质量指数[body-mass index, BMI]、吸烟、饮酒及饮食情况）进行了调查。采用单因素及多因素比例风险回归模型评估生活方式行为对患者生存的影响。 结果 吸烟是患者生存的独立预测因素：当前吸烟者[风险比（hazard ratio, HR）=1.88；95%置信区间（confidence interval, CI）：1.33~2.65]及重度吸烟者（≥25包-年；HR=1.84；95%CI：1.30~2.60）均与较差的生存结局显著相关。较高的体质量指数与更低的死亡风险显著相关（趋势检验P=0.002）。与体质量偏低及正常体重患者（BMI<22.99 kg/m²）相比，超重及肥胖患者的多因素校正生存风险比分别为0.66（95%CI：0.48~0.90）和0.47（95%CI：0.23~0.97）。单因素分析显示，无饮酒习惯及高水果摄入与良好的生存结局相关，但在多因素模型中该关联不再具有统计学显著性。 结论 本研究结果表明，治疗前的生活方式行为（尤其是吸烟状态与体质量指数）作为易于获取的临床数据，可为鼻咽癌患者的生存预后提供参考价值。