Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy Journal Article


Authors: Rink, M.; Xylinas, E.; Margulis, V.; Cha, E. K.; Ehdaie, B.; Raman, J. D.; Chun, F. K.; Matsumoto, K.; Lotan, Y.; Furberg, H.; Babjuk, M.; Pycha, A.; Wood, C. G.; Karakiewicz, P. I.; Fisch, M.; Scherr, D. S.; Shariat, S. F.
Article Title: Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy
Abstract: Background: Cigarette smoking is a common risk factor for developing upper tract urothelial carcinoma (UTUC). Objective: To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on oncologic UTUC outcomes in patients treated with radical nephroureterectomy (RNU). Design, setting, and participants: A total of 864 patients underwent RNU at five institutions. The median follow-up in this retrospective study was 50 mo. Smoking history included smoking status, quantity of cigarettes per day (CPD), duration in years, and years from smoking cessation. The cumulative smoking exposure was categorized as light-short-term (≤19 CPD and ≤19.9 yr), moderate (all combinations except light-short-term and heavy-long-term), and heavy-long-term (≥20 CPD and ≥20 yr). Interventions: RNU with or without lymph node dissection. No patient received neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on oncologic outcomes. Results and limitations: A total of 244 patients (28.2%) never smoked; 297 (34.4%) and 323 (37.4%) were former and current smokers, respectively. Among smokers, 87 (10.1%), 331 (38.3%), and 202 (23.4%) were light-short-term, moderate, and heavy-long-term smokers, respectively. Current smoking status, smoking ≥20 CPD, ≥20 yr, and heavy-long-term smoking were associated with advanced disease (p values ≤0.004), greater likelihood of disease recurrence (p values ≤0.01), and cancer-specific mortality (p values ≤0.05) on multivariable analyses that adjusted for standard features. Patients who quit smoking ≥10 yr prior to RNU did not differ from never smokers regarding advanced tumor stages, disease recurrence, and cancer-specific mortality, but they had better oncologic outcomes then current smokers and those patients who quit smoking <10 yr prior to RNU. The study is limited by its retrospective nature. Conclusions: Cigarette smoking is significantly associated with advanced disease stages, disease recurrence, and cancer-specific mortality in patients treated with RNU for UTUC. Current smokers and those with a heavy and long-term smoking exposure have the highest risk for poor oncologic outcomes. Smoking cessation >10 yr prior to RNU seems to mitigate some detrimental effects. These results underscore the need for smoking cessation and prevention programs. © 2012 European Association of Urology.
Keywords: survival; adult; treatment outcome; aged; middle aged; retrospective studies; major clinical study; cancer recurrence; advanced cancer; cancer staging; outcome assessment; lymph node metastasis; lymph node dissection; cancer grading; disease association; logistic models; risk factors; smoking cessation; recurrence; smoking; retrospective study; kidney neoplasms; nephrectomy; cancer mortality; risk assessment; cancer specific survival; urothelial carcinoma; nephroureterectomy; ureteral neoplasms; ureter; carcinoma, transitional cell; kidney pelvis; transitional cell carcinoma; environmental exposure; dose-response relationship; recurrence free survival; tumor necrosis; radical nephroureterectomy; cancer prognosis; neoplasm grading; upper urinary tract
Journal Title: European Urology
Volume: 63
Issue: 6
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2013-06-01
Start Page: 1082
End Page: 1090
Language: English
PROVIDER: scopus
PUBMED: 22743166
DOI: 10.1016/j.eururo.2012.06.029
PMCID: PMC3969987
DOI/URL:
Notes: --- - Cited By (since 1996):2 - "Export Date: 1 May 2013" - "CODEN: EUURA" - ":doi 10.1016/j.eururo.2012.06.029" - "Source: Scopus"
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