Smoking negatively impacts renal cell carcinoma overall and cancer‐specific survival

• Published in: Cancer Vol. 118; no. 7; pp. 1795 - 1802
• Main Authors: Kroeger, Nils, Klatte, Tobias, Birkhäuser, Frédéric D., Rampersaud, Edward N., Seligson, David B., Zomorodian, Nazy, Kabbinavar, Fairooz F., Belldegrun, Arie S., Pantuck, Allan J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.04.2012; Wiley-Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; cancer specific survival; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - pathology; Carcinoma, Renal Cell - secondary; Female; Humans; immunohistochemistry; Kidney Neoplasms - diagnosis; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Male; Medical sciences; Middle Aged; overall survival; p53; renal cell carcinoma; smoking; Smoking - adverse effects; Survival Analysis; tissue microarray; Tobacco, tobacco smoking; Toxicology; Tumors; Kidney disease; Immunohistochemistry; cancer specific survival; Urinary system disease; Carcinoma; tissue microarray; Tobacco smoking; Malignant tumor; Survival; p53; Anatomic pathology; renal cell carcinoma; Cancerology; TP53 Gene; Tissue microarrays; Kidney cancer; smoking; overall survival; Grawitz tumor; Cancer; Tumor suppressor gene
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.26453

BACKGROUND: Tobacco use is a leading cause of premature death, yet few studies have investigated the effect of tobacco exposure on the outcome of patients with renal cell carcinoma (RCC). The authors of this report retrospectively studied the impact of smoking on clinicopathologic factors, survival outcomes, and p53 expression status in a large cohort of patients with RCC. METHODS: Eight hundred‐two patients (457 nonsmokers and 345 smokers) who had up to 232 months of follow‐up were compared for differences in their clinicopathologic features and survival outcomes. Immunohistochemical differences in p53 expression were correlated with smoking status. RESULTS: Smokers presented more commonly with pulmonary comorbidities (P < .0001) and cardiac comorbidities (P = .014) and with a worse performance status (P = .031) than nonsmokers. Smoking was associated significantly with tumor multifocality (P = .022), higher pathologic tumor classification (P = .037), an increased risk of bulky lymph node metastases (P = .031), and the presence of distant metastases (P < .0001), especially lung metastases (P < .0001). Both overall survival (OS) (62.37 months vs 43.64 months; P = .001) and cancer‐specific survival (CSS) (87.43 months vs 56.57 months; P = .005) were significantly worse in patients who smoked. The number of pack‐years was retained as an independent predictor of CSS and OS in patients with nonmetastatic disease. Mean expression levels of p53 were significantly higher in current smokers compared with former smokers and nonsmokers (P = .012). CONCLUSIONS: In patients with RCC, a history of smoking was associated with worse pathologic features and survival outcomes and with an increased risk of having mutated p53. Further investigation of the genetic and molecular mechanisms associated with decreased CSS in patients with RCC who have a history of smoking is indicated. Cancer 2012;. © 2011 American Cancer Society. This retrospective study of 802 patients with renal cell carcinoma demonstrates an association between smoking and worse clinicopathologic features, a dose‐dependent relation with survival outcome, and an increased risk of p53 mutation. Further investigations of the molecular and genetic mechanisms underlying these findings are indicated.