629 IMPACT OF SMOKING STATUS AT DIAGNOSIS ON DISEASE RECURRENCE AND DEATH IN CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (I)1 Apr 2013629 IMPACT OF SMOKING STATUS AT DIAGNOSIS ON DISEASE RECURRENCE AND DEATH IN CLEAR CELL RENAL CELL CARCINOMA Behfar Ehdaie, Helena Furberg, Emily Zabor, Ari Hakimi, and Paul Russo Behfar EhdaieBehfar Ehdaie New York, NY , Helena FurbergHelena Furberg New York, NY , Emily ZaborEmily Zabor New York, NY , Ari HakimiAri Hakimi New York, NY , and Paul RussoPaul Russo New York, NY View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.181AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The increased use of cross sectional imaging has contributed to the rising prevalence of incidental renal masses; however, earlier detection has not decreased the risk of kidney cancer mortality. Modifiable risk factors have increasingly been associated with kidney cancer survival. Despite recent reports describing an association with smoking exposure and kidney cancer stage at diagnosis, the impact of smoking on cancer-specific outcomes is understudied. We evaluated the impact of smoking exposure on oncological outcomes in patients with clear cell renal cell carcinoma (ccRCC) treated with surgery. METHODS After IRB approval, patient and disease characteristics from 1,625 patients with non-metastatic ccRCC treated with partial or radical nephrectomy between 1995 through 2012 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 lymph nodes. Factors associated smoking status and advanced disease (> AJCC stage 2), disease recurrence, cancer-specific death, and overall mortality were determined. RESULTS The prevalence of current, former, and never smoking at diagnosis was 16%, 30%, and 54%, respectively. 62.4% of patients reported a ≥20 pack-year smoking history. With a median follow up 4.5 years, disease recurrence occurred in 10.5% (n=170) and 19.4% (n=316) died during follow-up. Multivariate logistic regression demonstrated ≥20 pack-year smoking history was associated with a significantly increased risk of advanced disease (> AJCC stage 2). While pathologic stage, Fuhrman grade, and systemic symptoms at presentation adversely affected cancer-specific survival, smoking status was not associated risk of recurrence or death in multivariate analysis (p=0.34). Multivariate competing risks regression showed that current smokers faced a significantly higher risk of death than never smokers (hazard ratio 1.77, 95% confidence interval 1.23-2.44). CONCLUSIONS Patients with heavy smoking exposure presented with more advanced clear ccRCC. While smoking status at diagnosis and cumulative smoking exposure were not associated with clear cell renal cell carcinoma recurrence or cancer-specific death, our findings suggest that smoking exposure substantially increases risk of death in patients with ccRCC. Treatment plans to promote smoking cessation are recommended for these patients. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e257 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Behfar Ehdaie New York, NY More articles by this author Helena Furberg New York, NY More articles by this author Emily Zabor New York, NY More articles by this author Ari Hakimi New York, NY More articles by this author Paul Russo New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...