男性肺がん患者の術前喫煙と禁煙時間が術前末梢血炎症性指標と術後入院成績に与える影響と手術治療の影響

Impacts of Preoperative Smoking and Smoking Cessation Time on Preoperative Peripheral Blood Inflammatory Indexes and Postoperative Hospitalization Outcome in Male Patients with Lung Cancer and Surgery Treatment.

• Long Ming Xu
• Shui Ping Dai
• Yun Xia Zuo

抄録

目的 s 男性肺がん患者の術前喫煙と禁煙時間が術前末梢血炎症指標および手術療法後の入院成績に及ぼす影響を検討する。 方法 2014年1月から2016年12月の間に根治性肺がん切除術を受けた男性患者637名をレトロスペクティブに登録した。患者を喫煙歴に基づいて現在喫煙者、非喫煙者、元喫煙者に分類し、元喫煙者は禁煙時間（CeT）に応じて5つのサブグループに割り付けた。CeT≦6週間、6週間<CeT≦1年、1年<CeT≦5年、5年<CeT≦10年、CeT＞10年。術前末梢血白血球数（WBCs）、アルブミン、好中球対リンパ球比（NLR）、血小板対リンパ球比（PLR）、術中出血量、30日死亡率、入院日数、入院費用、集中治療室（ICU）、入院日数、胸腔閉鎖型ドレナージチューブの装着時間を各群間で比較した。結果 喫煙者の血中WBC（=5.275、<0.001）とアルブミン（=2.470、<0.05）には、喫煙者、禁煙期間の異なる元喫煙者、非喫煙者の間で有意差が認められた。血中WBC値は，現在喫煙者（7.7×10 /L）が元喫煙者（7.0×10 /L），非喫煙者（5.9×10 /L）に比べて有意に高かった（それぞれ=-2.145，<0.05；=-6.073，<0.01）．現在喫煙者（41.1g/L）の末梢血アルブミン値は、元喫煙者（42.1g/L）および非喫煙者（43.2g/L）よりも低かった（それぞれ、=2.323、<0.05; =3.995、<0.01）。現在の喫煙者（3.7）の末梢血NLRレベルは、元喫煙者（3.1）および非喫煙者（2.8）よりも高かった（それぞれ、=-1.836、<0.05; =-2.889、<0.01）。禁煙時期の異なる5つのサブグループ間では，WBC，アルブミン，NLRに有意差は認められなかった．術中出血量、30日死亡率、入院費、入院期間、ICU滞在期間、胸腔閉鎖型ドレナージチューブ留置時間には、いずれの群においても有意差は認められなかった。結論 喫煙は肺癌患者の末梢血中の術前炎症性指標を増加させる。禁煙はこれらの炎症性指標の低下に有益な効果があるが、禁煙期間の長短は影響しないと考えられる。したがって、肺がん患者さんはいつでも禁煙することをお勧めします。

Objective s To investigate the effects of preoperative smoking and smoking cessation time on preoperative peripheral blood inflammatory indexes and postoperative hospitalization outcomes in male patients with lung cancer and surgery therapy.Methods We retrospectively enrolled 637 male patients who underwent curative-intent lung cancer resection between January 2014 and December 2016. Patients were classified as the current smokers, the never smokers, and the ex-smokers based on their smoking history, and the ex-smokers were allocated into five subgroups according to their smoking cessation times (CeT): CeT≤6 weeks, 6weeks<CeT≤1year, 1year<CeT≤5years, 5years<CeT≤10years, CeT>10years. The preoperative peripheral blood white blood cells (WBCs), albumin, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), intraoperative blood loss, 30-day mortality, in-hospital days, hospitalization costs, intensive care unit (ICU), admission days and placement time of closed thoracic drainage tube were compared among different groups.Results There were significant differences in WBC (=5.275, <0.001) and albumin (=2.470, <0.05) among patients of current smokers, ex-smokers with different smoking cessation time, and never-smokers. The blood WBC count in current smokers (7.7×10 /L) was significantly higher than that in ex-smokers (7.0×10 /L)and never-smokers (5.9×10 /L) (=-2.145, <0.05; =-6.073, <0.01, respectively). The level of peripheral blood albumin in current smokers (41.1 g/L) was lower than that in ex-smokers (42.1 g/L) and never-smokers (43.2 g/L) (=2.323, <0.05; =3.995, <0.01, respectively). The level of peripheral blood NLR in current smokers (3.7) was higher than that in ex-smokers (3.1) and never smokers (2.8) (=-1.836, <0.05; =-2.889, <0.01, respectively). There was no significant difference in WBC, albumin and NLR among five subgroups of different smoking cessation time. No significant difference was observed in intraoperative blood loss, 30-day mortality, hospitalization costs, hospital stay, ICU stay and placement time of closed thoracic drainage tube among groups either. Conclusion Smoking increases the preoperative inflammatory indexes in peripheral blood of lung cancer patients. Smoking cessation has beneficial effect on reducing levels of these inflammatory indexes, which may be not impacted by the time length of smoking cessation. Therefore, lung cancer patients should be encouraged to quit smoking at any time.