title: Smoking, alcohol use, obesity, and overall survival from non-Hodgkin lymphoma: a population-based study.
abstract: BACKGROUND
  Smoking, alcohol use, and obesity appear to increase the risk of developing non-Hodgkin lymphoma (NHL), but to the authors' knowledge, few studies to date have assessed their impact on NHL prognosis.
  
  
  METHODS
  The association between prediagnosis cigarette smoking, alcohol use, and body mass index (BMI) and overall survival was evaluated in 1286 patients enrolled through population-based registries in the United States from 1998 through 2000. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox regression, adjusting for clinical and demographic factors.
  
  
  RESULTS
  Through 2007, 442 patients had died (34%), and the median follow-up for surviving patients was 7.7 years. Compared with never smokers, former (HR, 1.59; 95% CI, 1.12-2.26) and current (HR, 1.50; 95% CI, 0.97-2.29) smokers had poorer survival, and poorer survival was found to be positively associated with smoking duration, number of cigarettes smoked per day, pack-years of smoking, and shorter time since quitting (all P <0.01). Alcohol use was associated with poorer survival (P = 0.03); compared with nonusers. Those drinking >43.1 g/week (median intake among drinkers) had poorer survival (HR, 1.55; 95% CI, 1.06-2.27), whereas those drinkers consuming less than this amount demonstrated no survival disadvantage (HR, 1.13; 95% CI, 0.75-1.71). Greater BMI was associated with poorer survival (P = 0.046), but the survival disadvantage was only noted among obese individuals (HR, 1.32 for BMI > or = 30 vs BMI 20-24.9; 95% CI, 1.02-1.70). These results held for lymphoma-specific survival and were broadly similar for diffuse large B-cell lymphoma and follicular lymphoma.
  
  
  CONCLUSIONS
  NHL patients who smoked, consumed alcohol, or were obese before diagnosis were found to have a poorer overall and lymphoma-specific survival.
authors.affiliation: Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Geyer
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Morton
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Habermann
authors.forename: Cristine
authors.initials: C
authors.lastname: Allmer
authors.forename: Scott
authors.initials: S
authors.lastname: Davis
authors.forename: Wendy
authors.initials: W
authors.lastname: Cozen
authors.forename: Richard K
authors.initials: RK
authors.lastname: Severson
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.forename: Sophia S
authors.initials: SS
authors.lastname: Wang
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Maurer
authors.forename: Patricia
authors.initials: P
authors.lastname: Hartge
authors.forename: James R
authors.initials: JR
authors.lastname: Cerhan
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D011159:Population Surveillance; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality