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Both current and former cigarette smokers with upper tract urothelial carcinoma (UTUC) have worse cancer-specific and overall survival compared with nonsmokers, investigators reported at the Society of Urologic Oncology’s 24nd Annual Meeting in Washington, DC. Cigarette smoking does not appear to affect response to neoadjuvant chemotherapy, however.
Survival
In a study of 1041 patients with UTUC who underwent radical nephroureterectomy, 5-year cancer-specific survival rates significantly decreased as cigarette smoking burden increased: 97% in non-smokers, 89% in light to moderate smokers, and 75% in heavy smokers. On multivariable competing risk regression, the risk for cancer-specific mortality was significantly increased 3.0- and 3.2-fold with light to moderate smoking and heavy smoking, respectively, Raj Bhanvadia, MD, of UT Southwestern Medical Center in Dallas, Texas, reported on behalf of his team.
The 5-year overall survival rate also significantly decreased with greater cigarette smoking: 91% in non-smokers, 68% in light to moderate smokers, and 60% in heavy smokers. The risk for all-cause mortality was significantly increased 3.6- and 2.7-fold with light to moderate smoking and heavy smoking, respectively.
These findings underscore the continued need for more aggressive smoking cessation and prevention programs for patients with UTUC, Dr Bhanvadia told Renal & Urology News.
Light smoking was defined as 19 or fewer cigarettes per day and 19 or fewer years of smoking. Heavy smoking was defined as more than 20 cigarettes per day and more than 20 years of smoking. All in-between cases were considered moderate smoking.
Marijuana smoke contains many similar carcinogens to cigarette smoke, but the relationship between marijuana smoking and cancer risk is not yet clear.
“Certainly, as marijuana use continues to increase nationwide, this appears an area that warrants further investigation across all cancers,” Dr Bhanvadia said.
Response to Neoadjuvant Chemo
Cigarette smoking burden was not associated with pathologic downstaging of UTUC after neoadjuvant chemotherapy on multivariable regression, Dr Bhanvadia added.
“This is important because a recent meta-analysis in the Journal of Urology showed lower rates of neoadjuvant chemotherapy response among smokers in the radical cystectomy population, which often serves as a proxy for UTUC,” he said.
A recent study published in JAMA Internal Medicine found that healthy adults who quit cigarette smoking cut their excess risks for cancer, cardiovascular, and respiratory mortality by more than 50% in the first 10 years.
References
Bhanvadia RR, Holland L, Popokh B. Association between smoking burden and oncologic outcomes of upper tract urothelial carcinoma: Analysis of the ROBUUST collaboration. Presented at the Society of Urologic Oncology 24nd annual meeting, November 28-December 1, 2023. Poster 59.
Thomson B, Islami F. Association of smoking cessation and cardiovascular, cancer, and respiratory mortality. JAMA Intern Med. Published online November 27, 2023. doi:10.1001/jamainternmed.2023.6419
This article originally appeared on Renal and Urology News
