title: Combined heavy smoking and drinking predicts overall but not disease-free survival after curative resection of locoregional esophageal squamous cell carcinoma.
abstract: BACKGROUND
  The prognostic impact of smoking and drinking on esophageal squamous cell carcinoma (ESCC) was scarcely discussed. We investigated the prognostic value of smoking and drinking and their relationships with clinicopathological characteristics in a large cohort of patients with locoregional ESCC.
  
  
  METHODS
  We retrospectively analyzed 488 patients who underwent curative treatment at a single institution between January 2007 and December 2008. A chi-square test was used to evaluate the relationships between smoking and drinking and clinicopathological variables, the Kaplan-Meier method was used for 5-year overall survival (OS) and disease-free survival, and Cox proportional hazards models were applied for univariate and multivariate analyses of variables with respect to OS and disease-free survival.
  
  
  RESULTS
  Heavy smokers were more likely to have advanced Tumor-Node-Metastases (TNM) stage and higher neutrophil/lymphocyte ratio at diagnosis (P<0.05). Drinkers were more likely to have advanced TNM stage, to present with a larger tumor, and to undergo multidisciplinary treatment (P<0.05). For patients who used neither heavy tobacco nor alcohol, used either tobacco or alcohol, and used both, the 5-year OS rates and OS times were 57.4%, 46.4%, and 39.1% (P<0.05) and not reached, 55.2 months, and 41.2 months (P<0.05), respectively. On multivariate analysis, patients who both heavily smoked and drank had 1.392 times the risk of dying during follow-up compared with neither-users (95% CI =1.020-1.901, P=0.037).
  
  
  CONCLUSIONS
  We identified that combined heavy smoking and drinking might predict poor prognosis in ESCC patients.
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Peng
authors.initials: P
authors.lastname: Sun
authors.affiliation: Department of Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, People's Republic of China.
authors.forename: Cui
authors.initials: C
authors.lastname: Chen
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Fei
authors.initials: F
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Hang
authors.initials: H
authors.lastname: Yang
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Xi-Wen
authors.initials: XW
authors.lastname: Bi
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Xin
authors.initials: X
authors.lastname: An
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Feng-Hua
authors.initials: FH
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine; Department of Medical Oncology, Sun Yat-Sen University Cancer Center.
authors.forename: Wen-Qi
authors.initials: WQ
authors.lastname: Jiang
keywords: drinking; esophageal squamous cell carcinoma; prognosis; smoking; survival