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

TY - JOUR

T1 - Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy.

AU - Rink, Michael

AU - Xylinas, Evanguelos

AU - Margulis, Vitaly

AU - Cha, Eugene K

AU - Ehdaie, Behfar

AU - Raman, Jay D

AU - Chun, Felix K

AU - Matsumoto, Kazumasa

AU - Lotan, Yair

AU - Furberg, Helena

AU - Babjuk, Marek

AU - Pycha, Armin

AU - Wood, Christopher G

AU - Karakiewicz, Pierre I

AU - Fisch, Margit

AU - Scherr, Douglas S

AU - Shariat, Shahrokh F

AU - Upper Tract Urothelial Carcinoma Collaboration (UTUCC)

N1 - Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2013

Y1 - 2013

N2 - 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.

AB - 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.

KW - Aged

KW - Carcinoma, Transitional Cell

KW - Female

KW - Humans

KW - Kidney Neoplasms

KW - Kidney Pelvis

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Neoplasm Grading

KW - Nephrectomy

KW - Prognosis

KW - Retrospective Studies

KW - Risk Factors

KW - Smoking

KW - Treatment Outcome

KW - Ureter

KW - Ureteral Neoplasms

U2 - 10.1016/j.eururo.2012.06.029

DO - 10.1016/j.eururo.2012.06.029

M3 - SCORING: Journal article

C2 - 22743166

VL - 63

SP - 1082

EP - 1090

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 6

M1 - 6

ER -