Gender-specific effect of smoking on upper tract urothelial carcinoma outcomes

TY - JOUR

T1 - Gender-specific effect of smoking on upper tract urothelial carcinoma outcomes

AU - Rink, Michael

AU - Xylinas, Evanguelos

AU - Trinh, Quoc-Dien

AU - Lotan, Yair

AU - Margulis, Vitaly

AU - Raman, Jay D

AU - Fisch, Margit

AU - Lee, Richard K

AU - Chun, Felix K

AU - Abdennabi, Joual

AU - Seitz, Christian

AU - Pycha, Armin

AU - Zlotta, Alexandre R

AU - Karakiewicz, Pierre I

AU - Babjuk, Marko

AU - Scherr, Douglas S

AU - Shariat, Shahrokh F

AU - Upper Tract Urothelial Carcinoma Collaboration (UTUCC)

N1 - © 2013 BJU International.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - OBJECTIVE: To evaluate the gender-specific differential effects of smoking habits and cumulative smoking exposure on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).PATIENTS AND METHODS: A total of 864 consecutive patients, comprising 553 (64%) men and 311 (36%) women, from five international institutions underwent RNU without neoadjuvant chemotherapy. Smoking history included smoking status (current, former or never), quantity of cigarettes per day (CPD), smoking duration in years and years since smoking cessation. Cumulative smoking exposure was categorized as light short-term (≤19 CPD and ≤19.9 years), moderate (all combinations except light short-term and heavy long-term), and heavy long-term (≥20 CPD and ≥20 years). Uni- and multivariable competing risk regression models were used to assess the associations with outcomes.RESULTS: Overall, 244 (28.2%), 297 (34.4%) and 323 (37.4%) patients were never, former and current smokers, respectively. There were no differences in smoking status, quantity and duration between the genders. In female ever smokers, 30 (9.6%), 121 (38.9%) and 67 (21.5%) were light short-term, moderate and heavy long-term smokers, respectively. Compared with men, female current smokers were more likely to experience disease recurrence in univariable analysis (P = 0.013). In heavy long-term smokers, female gender was significantly associated with disease recurrence (hazard ratio [HR] 1.7; P = 0.03) and cancer-specific mortality (HR 2.0; P = 0.009) in multivariable analysis that adjusted for standard clinico-pathological features. In female patients only, smoking quantity, duration and cumulative exposure were associated with disease recurrence and cancer-specific mortality on multivariable analyses (P ≤ 0.025).CONCLUSIONS: The impact of smoking on UTUC outcomes after RNU is gender-specific. Females who are current and heavy long-term smokers experience worse outcomes than their male counterparts. Further research is needed to elucidate the molecular mechanisms underlying the gender-specific differential effect of smoking on UTUC outcomes.

AB - OBJECTIVE: To evaluate the gender-specific differential effects of smoking habits and cumulative smoking exposure on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).PATIENTS AND METHODS: A total of 864 consecutive patients, comprising 553 (64%) men and 311 (36%) women, from five international institutions underwent RNU without neoadjuvant chemotherapy. Smoking history included smoking status (current, former or never), quantity of cigarettes per day (CPD), smoking duration in years and years since smoking cessation. Cumulative smoking exposure was categorized as light short-term (≤19 CPD and ≤19.9 years), moderate (all combinations except light short-term and heavy long-term), and heavy long-term (≥20 CPD and ≥20 years). Uni- and multivariable competing risk regression models were used to assess the associations with outcomes.RESULTS: Overall, 244 (28.2%), 297 (34.4%) and 323 (37.4%) patients were never, former and current smokers, respectively. There were no differences in smoking status, quantity and duration between the genders. In female ever smokers, 30 (9.6%), 121 (38.9%) and 67 (21.5%) were light short-term, moderate and heavy long-term smokers, respectively. Compared with men, female current smokers were more likely to experience disease recurrence in univariable analysis (P = 0.013). In heavy long-term smokers, female gender was significantly associated with disease recurrence (hazard ratio [HR] 1.7; P = 0.03) and cancer-specific mortality (HR 2.0; P = 0.009) in multivariable analysis that adjusted for standard clinico-pathological features. In female patients only, smoking quantity, duration and cumulative exposure were associated with disease recurrence and cancer-specific mortality on multivariable analyses (P ≤ 0.025).CONCLUSIONS: The impact of smoking on UTUC outcomes after RNU is gender-specific. Females who are current and heavy long-term smokers experience worse outcomes than their male counterparts. Further research is needed to elucidate the molecular mechanisms underlying the gender-specific differential effect of smoking on UTUC outcomes.

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Transitional Cell

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Kaplan-Meier Estimate

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Nephrectomy

KW - Prognosis

KW - Retrospective Studies

KW - Risk Assessment

KW - Sex Distribution

KW - Sex Factors

KW - Smoking

KW - Smoking Cessation

KW - Time Factors

KW - Ureteral Neoplasms

KW - Urothelium

U2 - 10.1111/bju.12014

DO - 10.1111/bju.12014

M3 - SCORING: Journal article

C2 - 23465088

VL - 112

SP - 623

EP - 637

JO - BJU INT

JF - BJU INT

SN - 1464-4096

IS - 5

ER -