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

Michael Rink, Evanguelos Xylinas, Vitaly Margulis, Eugene K. Cha, Behfar Ehdaie, Jay D. Raman, Felix K. Chun, Kazumasa Matsumoto, Yair Lotan, Helena Furberg, Marek Babjuk, Armin Pycha, Christopher G. Wood, Pierre I. Karakiewicz, Margit Fisch, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)1082-1090
Number of pages9
JournalEuropean Urology
Volume63
Issue number6
DOIs
StatePublished - Jun 2013

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Smoking
Carcinoma
Tobacco Products
Smoking Cessation
Light
Recurrence
Neoplasms
Mortality
Lymph Node Excision
Retrospective Studies
Logistic Models
History
Regression Analysis
Drug Therapy

Keywords

  • Dose-response relationship
  • Prognosis
  • Radical nephroureterectomy
  • Recurrence
  • Smoking
  • Survival
  • Transitional cell carcinoma
  • Upper urinary tract
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. / Rink, Michael; Xylinas, Evanguelos; Margulis, Vitaly; Cha, Eugene K.; Ehdaie, Behfar; Raman, Jay D.; Chun, Felix K.; Matsumoto, Kazumasa; Lotan, Yair; Furberg, Helena; Babjuk, Marek; Pycha, Armin; Wood, Christopher G.; Karakiewicz, Pierre I.; Fisch, Margit; Scherr, Douglas S.; Shariat, Shahrokh F.

In: European Urology, Vol. 63, No. 6, 06.2013, p. 1082-1090.

Research output: Contribution to journalArticle

Rink, M, Xylinas, E, Margulis, V, Cha, EK, Ehdaie, B, Raman, JD, Chun, FK, Matsumoto, K, Lotan, Y, Furberg, H, Babjuk, M, Pycha, A, Wood, CG, Karakiewicz, PI, Fisch, M, Scherr, DS & Shariat, SF 2013, 'Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy', European Urology, vol. 63, no. 6, pp. 1082-1090. https://doi.org/10.1016/j.eururo.2012.06.029
Rink, Michael ; Xylinas, Evanguelos ; Margulis, Vitaly ; Cha, Eugene K. ; Ehdaie, Behfar ; Raman, Jay D. ; Chun, Felix K. ; Matsumoto, Kazumasa ; Lotan, Yair ; Furberg, Helena ; Babjuk, Marek ; Pycha, Armin ; Wood, Christopher G. ; Karakiewicz, Pierre I. ; Fisch, Margit ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. In: European Urology. 2013 ; Vol. 63, No. 6. pp. 1082-1090.
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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.",
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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.

PY - 2013/6

Y1 - 2013/6

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 - Dose-response relationship

KW - Prognosis

KW - Radical nephroureterectomy

KW - Recurrence

KW - Smoking

KW - Survival

KW - Transitional cell carcinoma

KW - Upper urinary tract

KW - Urothelial carcinoma

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U2 - 10.1016/j.eururo.2012.06.029

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SP - 1082

EP - 1090

JO - European Urology

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