PURPOSE: The impact of modifiable environmental factors on kidney cancer-specific outcomes is understudied.
We evaluated the impact of smoking exposure on cancer-specific survival (CSS) in clear cell renal cell carcinoma (ccRCC) patients treated with surgery.
MATERIALS AND METHODS: Characteristics from 1,625 ccRCC patients treated with surgery between 1995 through 2012 were collected from a prospectively maintained database at a single center. The associations between smoking status and both advanced disease (American Joint Committee on Cancer stage >2) and CSS were determined.
RESULTS: The prevalence rates of current, former, and never smoking at diagnosis were 16%, 30%, and 54%, respectively, and 62% of patients reported a ≥20 pack-year smoking history. The median follow-up period among survivors was 4.5 years (IQR2.2-7.9). On univariable analysis, ≥20 pack-year smoking history was associated with a significantly increased risk for advanced disease (OR 1.43, 95%CI 1.02-2.00); however it did not achieve an independent association after adjusting for age and gender. Pathologic stage and Fuhrman grade adversely affected CSS on multivariable competing risks analysis. Although the association between smoking and CSS did not achieve statistical significance on multivariable analysis, the direction of the central estimate (HR 1.5, 95%CI 0.89-2.52) suggests smoking adversely impacts CSS. Current smokers faced a higher risk for death from other causes as compared with never smokers (HR1.93, 95%CI 1.29-2.88).
CONCLUSIONS: Smoking exposure substantially increases risk for death from other causes and adversely impacts CSS in patients with ccRCC. Treatment plans to promote smoking cessation are recommended for these patients.
Written by:
Ehdaie B, Furberg H, Zabor EC, Hakimi AA, Russo P. Are you the author?
Urology Service, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Reference: J Urol. 2013 Sep 6. pii: S0022-5347(13)05328-7.
doi: 10.1016/j.juro.2013.08.081
PubMed Abstract
PMID: 24018238
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