Impact of smoking status at diagnosis on disease recurrence and death in upper tract urothelial carcinoma
What's known on the subject? and What does the study add? Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma is unknown. One study suggests that patients with a smoking history have an inc...
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Published in | BJU international Vol. 111; no. 4; pp. 589 - 595 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Oxford
Wiley-Blackwell
01.04.2013
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Abstract | What's known on the subject? and What does the study add?
Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma is unknown. One study suggests that patients with a smoking history have an increased risk of recurrence in the bladder compared with never smokers but these patients did not differ with respect to time to pelvic recurrence or distant metastasis.
We subdivided smokers into current and former smokers and performed multivariate analyses that showed that smoking status was not an independent predictor of recurrence when traditional prognostic factors were taken into account. In addition, competing risks analyses showed that although current smoking did not increase the risk of recurrence, it imparted a significant risk of dying compared with former and never smoking.
Objective
To evaluate the impact of smoking exposure on oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
Materials and Methods
Patient and disease characteristics from 288 patients with UTUC treated with RNU between 1995 and 2008 were collected from a prospectively maintained database at the Memorial Sloan‐Kettering Cancer Center.
Disease recurrence was defined as distant metastases, or local failure in the operative site or regional nodes.
Factors associated with recurrence and death were determined.
Results
The prevalence of current, former and never smoking at diagnosis was 19.1%, 55.2%, and 25.7%, respectively.
71.0% of patients reported a ≥20 pack‐year smoking history.
With a median follow‐up of 4.02 years, disease recurrence occurred in 27% (n = 79) of patients and 41% (n = 117) died during follow‐up.
While age at diagnosis, American Society of Anesthesiologists score, advanced stage, nodal involvement and high grade adversely affected recurrence‐free survival, smoking status was not associated with risk of recurrence or death in multivariate analysis (P = 0.60).
Multivariate competing risks regression showed that current smokers faced a significantly higher risk of death than never smokers (hazard ratio 3.64, 95% confidence interval 1.59–8.34).
Conclusions
While smoking status at diagnosis and cumulative smoking exposure were not associated with UTUC recurrence, our findings highlight the substantial risk of death in patients with UTUC who are active smokers.
Treatment plans to promote smoking cessation are recommended for these patients. |
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AbstractList | UNLABELLEDCigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma is unknown. One study suggests that patients with a smoking history have an increased risk of recurrence in the bladder compared with never smokers but these patients did not differ with respect to time to pelvic recurrence or distant metastasis. We subdivided smokers into current and former smokers and performed multivariate analyses that showed that smoking status was not an independent predictor of recurrence when traditional prognostic factors were taken into account. In addition, competing risks analyses showed that although current smoking did not increase the risk of recurrence, it imparted a significant risk of dying compared with former and never smoking. OBJECTIVETo evaluate the impact of smoking exposure on oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIALS AND METHODSPatient and disease characteristics from 288 patients with UTUC treated with RNU between 1995 and 2008 were collected from a prospectively maintained database at the Memorial Sloan-Kettering Cancer Center. Disease recurrence was defined as distant metastases, or local failure in the operative site or regional nodes. Factors associated with recurrence and death were determined. RESULTSThe prevalence of current, former and never smoking at diagnosis was 19.1%, 55.2%, and 25.7%, respectively. 71.0% of patients reported a ≥20 pack-year smoking history. With a median follow-up of 4.02 years, disease recurrence occurred in 27% (n = 79) of patients and 41% (n = 117) died during follow-up. While age at diagnosis, American Society of Anesthesiologists score, advanced stage, nodal involvement and high grade adversely affected recurrence-free survival, smoking status was not associated with risk of recurrence or death in multivariate analysis (P = 0.60). Multivariate competing risks regression showed that current smokers faced a significantly higher risk of death than never smokers (hazard ratio 3.64, 95% confidence interval 1.59-8.34). CONCLUSIONSWhile smoking status at diagnosis and cumulative smoking exposure were not associated with UTUC recurrence, our findings highlight the substantial risk of death in patients with UTUC who are active smokers. Treatment plans to promote smoking cessation are recommended for these patients. What's known on the subject? and What does the study add? Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma is unknown. One study suggests that patients with a smoking history have an increased risk of recurrence in the bladder compared with never smokers but these patients did not differ with respect to time to pelvic recurrence or distant metastasis. We subdivided smokers into current and former smokers and performed multivariate analyses that showed that smoking status was not an independent predictor of recurrence when traditional prognostic factors were taken into account. In addition, competing risks analyses showed that although current smoking did not increase the risk of recurrence, it imparted a significant risk of dying compared with former and never smoking. Objective To evaluate the impact of smoking exposure on oncological outcomes in patients with upper tract urothelial carcinoma ( UTUC ) treated with radical nephroureterectomy ( RNU ). Materials and Methods Patient and disease characteristics from 288 patients with UTUC treated with RNU between 1995 and 2008 were collected from a prospectively maintained database at the M emorial S loan‐ K ettering C ancer C enter. Disease recurrence was defined as distant metastases, or local failure in the operative site or regional nodes. Factors associated with recurrence and death were determined. Results The prevalence of current, former and never smoking at diagnosis was 19.1%, 55.2%, and 25.7%, respectively. 71.0% of patients reported a ≥20 pack‐year smoking history. With a median follow‐up of 4.02 years, disease recurrence occurred in 27% ( n = 79) of patients and 41% ( n = 117) died during follow‐up. While age at diagnosis, American Society of Anesthesiologists score, advanced stage, nodal involvement and high grade adversely affected recurrence‐free survival, smoking status was not associated with risk of recurrence or death in multivariate analysis ( P = 0.60). Multivariate competing risks regression showed that current smokers faced a significantly higher risk of death than never smokers (hazard ratio 3.64, 95% confidence interval 1.59–8.34). Conclusions While smoking status at diagnosis and cumulative smoking exposure were not associated with UTUC recurrence, our findings highlight the substantial risk of death in patients with UTUC who are active smokers. Treatment plans to promote smoking cessation are recommended for these patients. What's known on the subject? and What does the study add? Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma is unknown. One study suggests that patients with a smoking history have an increased risk of recurrence in the bladder compared with never smokers but these patients did not differ with respect to time to pelvic recurrence or distant metastasis. We subdivided smokers into current and former smokers and performed multivariate analyses that showed that smoking status was not an independent predictor of recurrence when traditional prognostic factors were taken into account. In addition, competing risks analyses showed that although current smoking did not increase the risk of recurrence, it imparted a significant risk of dying compared with former and never smoking. Objective To evaluate the impact of smoking exposure on oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods Patient and disease characteristics from 288 patients with UTUC treated with RNU between 1995 and 2008 were collected from a prospectively maintained database at the Memorial Sloan‐Kettering Cancer Center. Disease recurrence was defined as distant metastases, or local failure in the operative site or regional nodes. Factors associated with recurrence and death were determined. Results The prevalence of current, former and never smoking at diagnosis was 19.1%, 55.2%, and 25.7%, respectively. 71.0% of patients reported a ≥20 pack‐year smoking history. With a median follow‐up of 4.02 years, disease recurrence occurred in 27% (n = 79) of patients and 41% (n = 117) died during follow‐up. While age at diagnosis, American Society of Anesthesiologists score, advanced stage, nodal involvement and high grade adversely affected recurrence‐free survival, smoking status was not associated with risk of recurrence or death in multivariate analysis (P = 0.60). Multivariate competing risks regression showed that current smokers faced a significantly higher risk of death than never smokers (hazard ratio 3.64, 95% confidence interval 1.59–8.34). Conclusions While smoking status at diagnosis and cumulative smoking exposure were not associated with UTUC recurrence, our findings highlight the substantial risk of death in patients with UTUC who are active smokers. Treatment plans to promote smoking cessation are recommended for these patients. Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma is unknown. One study suggests that patients with a smoking history have an increased risk of recurrence in the bladder compared with never smokers but these patients did not differ with respect to time to pelvic recurrence or distant metastasis. We subdivided smokers into current and former smokers and performed multivariate analyses that showed that smoking status was not an independent predictor of recurrence when traditional prognostic factors were taken into account. In addition, competing risks analyses showed that although current smoking did not increase the risk of recurrence, it imparted a significant risk of dying compared with former and never smoking. To evaluate the impact of smoking exposure on oncological outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Patient and disease characteristics from 288 patients with UTUC treated with RNU between 1995 and 2008 were collected from a prospectively maintained database at the Memorial Sloan-Kettering Cancer Center. Disease recurrence was defined as distant metastases, or local failure in the operative site or regional nodes. Factors associated with recurrence and death were determined. The prevalence of current, former and never smoking at diagnosis was 19.1%, 55.2%, and 25.7%, respectively. 71.0% of patients reported a ≥20 pack-year smoking history. With a median follow-up of 4.02 years, disease recurrence occurred in 27% (n = 79) of patients and 41% (n = 117) died during follow-up. While age at diagnosis, American Society of Anesthesiologists score, advanced stage, nodal involvement and high grade adversely affected recurrence-free survival, smoking status was not associated with risk of recurrence or death in multivariate analysis (P = 0.60). Multivariate competing risks regression showed that current smokers faced a significantly higher risk of death than never smokers (hazard ratio 3.64, 95% confidence interval 1.59-8.34). While smoking status at diagnosis and cumulative smoking exposure were not associated with UTUC recurrence, our findings highlight the substantial risk of death in patients with UTUC who are active smokers. Treatment plans to promote smoking cessation are recommended for these patients. |
Author | Bochner, Bernard H. Dalbagni, Guido Zabor, Emily Craig Coleman, Jonathan A. Ehdaie, Behfar Ostroff, Jamie S. Shariat, Shahrokh F. Furberg, Helena |
AuthorAffiliation | Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center |
AuthorAffiliation_xml | – name: Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA – name: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center – name: Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers – name: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center – name: Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA |
Author_xml | – sequence: 1 givenname: Behfar surname: Ehdaie fullname: Ehdaie, Behfar organization: Memorial Sloan‐Kettering Cancer Center – sequence: 2 givenname: Helena surname: Furberg fullname: Furberg, Helena organization: Memorial Sloan‐Kettering Cancer Center – sequence: 3 givenname: Emily Craig surname: Zabor fullname: Zabor, Emily Craig organization: Memorial Sloan‐Kettering Cancer Center – sequence: 4 givenname: Jamie S. surname: Ostroff fullname: Ostroff, Jamie S. organization: Memorial Sloan‐Kettering Cancer Center – sequence: 5 givenname: Shahrokh F. surname: Shariat fullname: Shariat, Shahrokh F. organization: New York‐Presbyterian Hospital – sequence: 6 givenname: Bernard H. surname: Bochner fullname: Bochner, Bernard H. organization: Sidney Kimmel Center for Prostate and Urologic Cancers – sequence: 7 givenname: Jonathan A. surname: Coleman fullname: Coleman, Jonathan A. organization: Sidney Kimmel Center for Prostate and Urologic Cancers – sequence: 8 givenname: Guido surname: Dalbagni fullname: Dalbagni, Guido organization: Sidney Kimmel Center for Prostate and Urologic Cancers |
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Keywords | Nephrology Relapse Prognosis Disease Tobacco smoking Urology Nephrectomy Urinary bladder Surgery smoking urinary bladder neoplasms outcome assessment Diagnosis Urinary system disease Mortality Urinary tract disease Malignant tumor Upper urinary tract transitional cell carcinoma Bladder tumor Tobacco Treatment Urinary system Death Bladder disease Cancer |
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Snippet | What's known on the subject? and What does the study add?
Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on... Cigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial carcinoma... UNLABELLEDCigarette smoking is the leading cause of urothelial carcinoma; however, the impact of smoking on outcomes after surgery for upper tract urothelial... |
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SubjectTerms | Adult Aged Aged, 80 and over Biological and medical sciences Biopsy, Needle Carcinoma, Transitional Cell - diagnosis Carcinoma, Transitional Cell - mortality Carcinoma, Transitional Cell - surgery Cohort Studies Databases, Factual Disease-Free Survival Female Humans Immunohistochemistry Kaplan-Meier Estimate Kidney Neoplasms - diagnosis Kidney Neoplasms - mortality Kidney Neoplasms - surgery Male Medical sciences Middle Aged Multivariate Analysis Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - pathology nephrectomy Nephrectomy - methods Nephrology. Urinary tract diseases New York City outcome assessment prognosis Proportional Hazards Models Retrospective Studies Risk Assessment smoking Smoking - adverse effects Smoking Cessation - statistics & numerical data Survival Analysis tobacco Tobacco, tobacco smoking Toxicology Tumors of the urinary system Ureter - surgery Ureteral Neoplasms - diagnosis Ureteral Neoplasms - mortality Ureteral Neoplasms - surgery urinary bladder neoplasms Urinary Bladder Neoplasms - diagnosis Urinary Bladder Neoplasms - mortality Urinary Bladder Neoplasms - surgery Urinary tract. Prostate gland Urologic Neoplasms - diagnosis Urologic Neoplasms - mortality Urologic Neoplasms - surgery |
Title | Impact of smoking status at diagnosis on disease recurrence and death in upper tract urothelial carcinoma |
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