Smoking Behavior and Prognosis after Colorectal Cancer Diagnosis: A Pooled Analysis of 11 Studies

Elizabeth Alwers, Prudence R. Carr, Barbara Banbury, Viola Walter, Jenny Chang-Claude, Lina Jansen, David A. Drew, Edward Giovannucci, Hongmei Nan, Sonja I. Berndt, Wen Yi Huang, Anna Prizment, Richard B. Hayes, Lori C. Sakoda, Emily White, Julia Labadie, Martha Slattery, Robert E. Schoen, Brenda Diergaarde, Bethany Van GuelpenPeter T. Campbell, Ulrike Peters, Andrew T. Chan, Polly A. Newcomb, Michael Hoffmeister, Hermann Brenner

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies, but current evidence on smoking in association with survival after CRC diagnosis is limited. Methods: We pooled data from 12 345 patients with stage I-IV CRC from 11 epidemiologic studies in the International Survival Analysis in Colorectal Cancer Consortium. Cox proportional hazards regression models were used to evaluate the associations of prediagnostic smoking behavior with overall, CRC-speci?c, and non-CRC-speci?c survival. Results: Among 12 345 patients with CRC, 4379 (35.5%) died (2515 from CRC) over a median follow-up time of 7.5years. Smoking was strongly associated with worse survival in stage I-III patients, whereas no associa-tion was observed among stage IV patients. Among stage I-III patients, clear dose-response relationships with all survival outcomes were seen for current smokers. For example, current smokers with 40 or more pack-years had statistically signi?cantly worse over-all, CRC-speci?c, and non-CRC-speci?c survival compared with never smokers (hazard ratio [HR] 1/41.94, 95% con?dence interval [CI] 1/41.68 to 2.25; HR = 1.41, 95% CI = 1.12 to 1.78; and HR = 2.67, 95% CI = 2.19 to 3.26, respectively). Similar associations with all sur-vival outcomes were observed for former smokers who had quit for less than 10years, but only a weak association with non-CRC-speci?c survival was seen among former smokers who had quit for more than 10years. Conclusions: This large consortium of CRC patient studies provides compelling evidence that smoking is strongly associated with worse survival of stage I-III CRC patients in a clear dose-response manner. The detrimental effect of smoking was primarily related to noncolorectal cancer events, but current heavy smoking also showed an association with CRC-speci?c survival.

Original languageEnglish
Article numberpkab077
JournalJNCI Cancer Spectrum
Issue number5
StatePublished - 1 Oct 2021
Externally publishedYes


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