oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2026-25-4-5-20oncotomsk-4412Research ArticleЭПИДЕМИОЛОГИЧЕСКИЕ ИССЛЕДОВАНИЯEPIDEMIOGICAL STUDIESОтказ от курения улучшает прогноз онкологических больных и не уступает эффективности инновационной противоопухолевой терапииSmoking cessation improves the prognosis of cancer patients and is comparable to the effectiveness of innovative antitumor therapyhttps://orcid.org/0000-0002-2824-3704ЗаридзеД. Г.ZaridzeD. G.

Заридзе Давид Георгиевич - доктор медицинских наук, профессор, член-корреспондент РАН, руководитель отдела клинической эпидемиологии НИИ клинической онкологии им. академика РАН и РАМН Н.Н. Трапезникова, ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; президент, ООО «Противораковое общество России».

115522, Москва, Каширское шоссе, 24

Researcher ID (WOS) K-5605-2013. Autor ID (Scopus) 7005676681

David G. Zaridze - MD, DSc, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Clinical Epidemiology, Research Institute of Clinical Oncology named after Academician of the Russian Academy of Sciences and Russian Academy of Medical Sciences N.N. Trapeznikov, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; President,All-Russian Public Organization “Anti-Cancer Society of Russia”.

24, Kashirskoe Shosse, Moscow, 115522

Researcher ID (WOS) K-5605-2013. Autor ID (Scopus) 7005676681

dgzaridze@rcs-pror.orghttps://orcid.org/0000-0002-6847-9295МукерияА. Ф.MukeriaA. F.

Мукерия Ануш Феликсовна - доктор медицинских наук, ведущий научный сотрудник отдела клинической эпидемиологии НИИ клинической онкологии им. академика РАН и РАМН Н.Н. Трапезникова, ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; исполнительный директор, ООО «Противораковое общество России».

115522, Москва, Каширское шоссе, 24

Autor ID (Scopus) 6603026158

Anush F. Mukeria - MD, DSc, Leading Researcher, Department of Clinical Epidemiology, Research Institute of Clinical Oncology named after Academician of the Russian Academy of Sciences and Russian Academy of Medical Sciences N.N. Trapeznikov, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Executive director, All-Russian Public Organization “Anti-Cancer Society of Russia”.

24, Kashirskoe Shosse, Moscow, 115522

Autor ID (Scopus) 6603026158

https://orcid.org/0000-0003-2431-068XШаньгинаО. В.ShanginaO. V.

Шаньгина Оксана Валентиновна - кандидат медицинских наук, старший научный сотрудник отдела клинической эпидемиологии НИИ клинической онкологии им. академика РАН и РАМН Н.Н. Трапезникова, ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России.

115522, Москва, Каширское шоссе, 24

Researcher ID (WOS) E-9068-2019. Autor ID (Scopus) 13204358800

Oxana V. Shangina - MD, PhD, Senior Scientist, Department of Clinical Epidemiology, Research Institute of Clinical Oncology named after Academician of the Russian Academy of Sciences and Russian Academy of Medical Sciences N.N. Trapeznikov, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia.

24, Kashirskoe Shosse, Moscow, 115522

Researcher ID (WOS) E-9068-2019. Autor ID (Scopus) 13204358800

ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России; Общероссийская общественная организация «Противораковое общество России»РоссияN.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; All-Russian Public Organization “Anti-Cancer Society of Russia”Russian FederationФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaRussian Federation202621092026254520Copyright © Заридзе Д.Г., Мукерия А.Ф., Шаньгина О.В., 20262026Заридзе Д.Г., Мукерия А.Ф., Шаньгина О.В.Zaridze D.G., Mukeria A.F., Shangina O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/4412

Курение не только приводит к развитию рака, но и ухудшает прогноз онкологических больных. Цель исследования: а) изучить влияние отказа от курения на прогноз больных с диагнозом рака легкого и почки и б) сравнить эти результаты с эффективностью ингибиторов контрольных точек иммунитета (ИКТИ), одобренных Управлением по контролю качества пищевых продуктов и лекарственных средств США (Food and drug administration, Fda). Материал и методы. Когорта из 1 240 больных немелкоклеточным раком легкого (НМРЛ) I–IIIа стадии и 1 025 больных почечно-клеточным раком (ПКР). Опубликованы результаты рандомизированных клинических исследований (РКИ) по изучению эффективности ИКТИ. Результаты. У больных НМРЛ, которые отказались от курения, медиана выживаемости без прогрессирования (ВБП) на 21,6 мес больше, чем у продолжающих курить. Выгода в медиане ВБП, полученная в результате приема ниволумаба в адъювантном режиме (10,8 мес) и пембролизумаба как неоадъюванта (16,6 мес), уступает выгоде, полученной от отказа от курения. Снижение риска прогрессирования на 30 % (ОР=0,70) у больных, бросивших курить, сравнимо со снижением риска прогрессирования на 37 %, связанного с приемом ниволумаба + химиотерапия, и на 24 % – с приемом пембролизумаба в неоадъювантном режиме. Выгода в медиане ВБП у больных ПКР при отказе от курения в 36 мес, по сравнению с продолжением курения, значительно превосходит все результаты РКИ. Снижение риска общей выживаемости (ОВ) на 49 % (ОР=0,51) и ВБП на 55 % (ОР=0,45) смерти от рака почки на 46 % (ОР=0,54) у больных, бросивших курить, также превосходит соответствующие результаты РКИ: применение пембролизумаба как неоадъдюванта (ОР=0,68), ниволумаба + ипилумаба (ОР=0,63) и ленвантиниба + пембролизумаба (ОР ОВ=0,79, ОР ВБП=0,49). Эффективность отказа от курения универсальна и, в отличие от ИКТИ, не ограничена никакими клиническими группами. В пользу отказа от курения говорит и отсутствие побочных эффектов. Отказ от курения онкологических больных не уступает эффективности противоопухолевой терапии. Включение отказа от курения в схемы лечения повысит эффективность противоопухолевой терапии. Необходимы дальнейшие исследования.

Smoking not only leads to the development of cancer but also worsens the prognosis of cancer patients. Objective: to study the impact of smoking cessation on the prognosis of patients diagnosed with non-small cell lung cancer (NSCLC) and clear cell renal cell carcinoma (ccRCC), and to compare these results with the efficacy of FDA-approved immune checkpoint inhibitors (ICIs). Material and Methods: a) a cohort of 1.240 patients diagnosed with NSCLC (stages I-IIIA) and 1.025 patients diagnosed with (ccRCC), b) published results of randomized clinical trials (RCTS) examining the efficacy of ICIs. Results. In patients with NSCLC (stages I-IIIa) who quit smoking, the median progression free survival (mPFS) was 21.6 months greater than that in the patients who continued smoking. mPFS achieved in patients who were treated with adjuvant nivolumab (10.8 months) and neoadjuvant pembrolizumab (16.6 months) were inferior of the results of smoking cessation. The 30 % reduction in the risk of progression hazard ratio (HR=0.70) due to smoking cessation was comparable to the 37 % reduction in the risk of progression associated with nivolumab plus chemotherapy and the 24 % reduction associated with neoadjuvant pembrolizumab. In patients with ccRCC who quit smoking 36-month benefit in mPFS in comparison with continuation of smoking, exceed all relevant results from the presented RCTs. A 49 % (HR=51) and 55 % (HR=45) reduction in the risk of overall survival (OS) and progression in ccRCC patients who quit smoking exceed the corresponding results in RCTs: risk reductions due to use of pembrolizumab (HR=0.68), nivolumab plus ipilumab (HR=0.63), and lenvantinib plus pembrolizumab (HR=0.79). The effectiveness of smoking cessation is universal and, unlike ICIs, is not limited to any clinical groups. The absence of adverse side effects also supports smoking cessation.

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The authors declare that there are no conflicts of interest present.