Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy

Evanguelos Xylinas, Luis A. Kluth, Malte Rieken, Richard K. Lee, Maya Elghouayel, Vicenzo Ficarra, Vitaly Margulis, Yair Lotan, Morgan Rouprêt, Juan I. Martinez-Salamanca, Kazumasa Matsumoto, Christian Seitz, Pierre I. Karakiewicz, Marc Zerbib, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on intravesical recurrence (IVR) outcomes in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Patients and Methods In all, 519 patients underwent RNU at five institutions. Smoking history included smoking status, quantity of cigarettes smoked per day (cpd), duration, and time from cessation. The cumulative smoking exposure was categorised 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). Univariable/multivariable cox regression analyses assessed the effects of smoking on IVR. Results In all, 190 patients (36%) never smoked; 205 (40%) and 125 (24%) were former and current smokers, respectively. Among smokers, 42 (8%), 185 (36%), and 102 (20%) patients were light-short-term, moderate, and heavy-long-term smokers, respectively. Within a median follow-up of 37 months, 152 patients (29%) had IVR. Actuarial IVR-free-survival estimates (standard error) at 2, 5, and 10 years were 72 (2)%, 58 (3)%, and 51 (4)%, respectively. In multivariable analyses, current smoking status, smoking intensity (≥20 cpd), smoking duration (≥20 years), and heavy-long-term smoking were associated with higher risk of IVR (all P ≤ 0.01). Patients who quit smoking ≥10 years before RNU had better IVR outcomes than current smokers and those patients who quit smoking <10 years before RNU. Conclusions Cigarette smoking is significantly associated with IVR in patients treated with RNU for UTUC. Current and heavy-long-term smokers have the highest risk of IVR. Smoking cessation for >10 years before RNU seems to mitigate these detrimental effects.

Original languageEnglish (US)
Pages (from-to)56-61
Number of pages6
JournalBJU International
Volume114
Issue number1
DOIs
StatePublished - 2014

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Smoking
Carcinoma
Recurrence
Tobacco Products
Light
History
Regression Analysis
Survival

Keywords

  • intravesical recurrence
  • radical nephroureterectomy
  • smoking
  • upper tract urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy. / Xylinas, Evanguelos; Kluth, Luis A.; Rieken, Malte; Lee, Richard K.; Elghouayel, Maya; Ficarra, Vicenzo; Margulis, Vitaly; Lotan, Yair; Rouprêt, Morgan; Martinez-Salamanca, Juan I.; Matsumoto, Kazumasa; Seitz, Christian; Karakiewicz, Pierre I.; Zerbib, Marc; Scherr, Douglas S.; Shariat, Shahrokh F.

In: BJU International, Vol. 114, No. 1, 2014, p. 56-61.

Research output: Contribution to journalArticle

Xylinas, E, Kluth, LA, Rieken, M, Lee, RK, Elghouayel, M, Ficarra, V, Margulis, V, Lotan, Y, Rouprêt, M, Martinez-Salamanca, JI, Matsumoto, K, Seitz, C, Karakiewicz, PI, Zerbib, M, Scherr, DS & Shariat, SF 2014, 'Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy', BJU International, vol. 114, no. 1, pp. 56-61. https://doi.org/10.1111/bju.12400
Xylinas, Evanguelos ; Kluth, Luis A. ; Rieken, Malte ; Lee, Richard K. ; Elghouayel, Maya ; Ficarra, Vicenzo ; Margulis, Vitaly ; Lotan, Yair ; Rouprêt, Morgan ; Martinez-Salamanca, Juan I. ; Matsumoto, Kazumasa ; Seitz, Christian ; Karakiewicz, Pierre I. ; Zerbib, Marc ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy. In: BJU International. 2014 ; Vol. 114, No. 1. pp. 56-61.
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title = "Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy",
abstract = "Objective To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on intravesical recurrence (IVR) outcomes in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Patients and Methods In all, 519 patients underwent RNU at five institutions. Smoking history included smoking status, quantity of cigarettes smoked per day (cpd), duration, and time from cessation. The cumulative smoking exposure was categorised 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). Univariable/multivariable cox regression analyses assessed the effects of smoking on IVR. Results In all, 190 patients (36{\%}) never smoked; 205 (40{\%}) and 125 (24{\%}) were former and current smokers, respectively. Among smokers, 42 (8{\%}), 185 (36{\%}), and 102 (20{\%}) patients were light-short-term, moderate, and heavy-long-term smokers, respectively. Within a median follow-up of 37 months, 152 patients (29{\%}) had IVR. Actuarial IVR-free-survival estimates (standard error) at 2, 5, and 10 years were 72 (2){\%}, 58 (3){\%}, and 51 (4){\%}, respectively. In multivariable analyses, current smoking status, smoking intensity (≥20 cpd), smoking duration (≥20 years), and heavy-long-term smoking were associated with higher risk of IVR (all P ≤ 0.01). Patients who quit smoking ≥10 years before RNU had better IVR outcomes than current smokers and those patients who quit smoking <10 years before RNU. Conclusions Cigarette smoking is significantly associated with IVR in patients treated with RNU for UTUC. Current and heavy-long-term smokers have the highest risk of IVR. Smoking cessation for >10 years before RNU seems to mitigate these detrimental effects.",
keywords = "intravesical recurrence, radical nephroureterectomy, smoking, upper tract urothelial carcinoma",
author = "Evanguelos Xylinas and Kluth, {Luis A.} and Malte Rieken and Lee, {Richard K.} and Maya Elghouayel and Vicenzo Ficarra and Vitaly Margulis and Yair Lotan and Morgan Roupr{\^e}t and Martinez-Salamanca, {Juan I.} and Kazumasa Matsumoto and Christian Seitz and Karakiewicz, {Pierre I.} and Marc Zerbib and Scherr, {Douglas S.} and Shariat, {Shahrokh F.}",
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T1 - Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy

AU - Xylinas, Evanguelos

AU - Kluth, Luis A.

AU - Rieken, Malte

AU - Lee, Richard K.

AU - Elghouayel, Maya

AU - Ficarra, Vicenzo

AU - Margulis, Vitaly

AU - Lotan, Yair

AU - Rouprêt, Morgan

AU - Martinez-Salamanca, Juan I.

AU - Matsumoto, Kazumasa

AU - Seitz, Christian

AU - Karakiewicz, Pierre I.

AU - Zerbib, Marc

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2014

Y1 - 2014

N2 - Objective To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on intravesical recurrence (IVR) outcomes in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Patients and Methods In all, 519 patients underwent RNU at five institutions. Smoking history included smoking status, quantity of cigarettes smoked per day (cpd), duration, and time from cessation. The cumulative smoking exposure was categorised 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). Univariable/multivariable cox regression analyses assessed the effects of smoking on IVR. Results In all, 190 patients (36%) never smoked; 205 (40%) and 125 (24%) were former and current smokers, respectively. Among smokers, 42 (8%), 185 (36%), and 102 (20%) patients were light-short-term, moderate, and heavy-long-term smokers, respectively. Within a median follow-up of 37 months, 152 patients (29%) had IVR. Actuarial IVR-free-survival estimates (standard error) at 2, 5, and 10 years were 72 (2)%, 58 (3)%, and 51 (4)%, respectively. In multivariable analyses, current smoking status, smoking intensity (≥20 cpd), smoking duration (≥20 years), and heavy-long-term smoking were associated with higher risk of IVR (all P ≤ 0.01). Patients who quit smoking ≥10 years before RNU had better IVR outcomes than current smokers and those patients who quit smoking <10 years before RNU. Conclusions Cigarette smoking is significantly associated with IVR in patients treated with RNU for UTUC. Current and heavy-long-term smokers have the highest risk of IVR. Smoking cessation for >10 years before RNU seems to mitigate these detrimental effects.

AB - Objective To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on intravesical recurrence (IVR) outcomes in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Patients and Methods In all, 519 patients underwent RNU at five institutions. Smoking history included smoking status, quantity of cigarettes smoked per day (cpd), duration, and time from cessation. The cumulative smoking exposure was categorised 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). Univariable/multivariable cox regression analyses assessed the effects of smoking on IVR. Results In all, 190 patients (36%) never smoked; 205 (40%) and 125 (24%) were former and current smokers, respectively. Among smokers, 42 (8%), 185 (36%), and 102 (20%) patients were light-short-term, moderate, and heavy-long-term smokers, respectively. Within a median follow-up of 37 months, 152 patients (29%) had IVR. Actuarial IVR-free-survival estimates (standard error) at 2, 5, and 10 years were 72 (2)%, 58 (3)%, and 51 (4)%, respectively. In multivariable analyses, current smoking status, smoking intensity (≥20 cpd), smoking duration (≥20 years), and heavy-long-term smoking were associated with higher risk of IVR (all P ≤ 0.01). Patients who quit smoking ≥10 years before RNU had better IVR outcomes than current smokers and those patients who quit smoking <10 years before RNU. Conclusions Cigarette smoking is significantly associated with IVR in patients treated with RNU for UTUC. Current and heavy-long-term smokers have the highest risk of IVR. Smoking cessation for >10 years before RNU seems to mitigate these detrimental effects.

KW - intravesical recurrence

KW - radical nephroureterectomy

KW - smoking

KW - upper tract urothelial carcinoma

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