Oncologic Effect of Cumulative Smoking Exposure in Patients Treated With Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer |
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| Authors: | Andrea Mari Mohammad Abufaraj Beat Foerster Mehmet ?zsoy Alberto Briganti Morgan Rouprêt Pierre I Karakiewicz Romain Mathieu David D&#x;Andrea Daher C Chade Shahrokh F Shariat |
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| Institution: | 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;2. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;3. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland;4. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria;5. Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy;6. Department of Urology, Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris and Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France;7. Department of Urology, University of Montreal, Montreal, Quebec, Canada;8. Department of Urology, Rennes University Hospital, Rennes, France;9. Department of Urology, Weill Cornell Medical College, New York, NY;10. Department of Urology, University of São Paulo Medical School and Institute of Cancer, São Paulo, Brazil;11. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX |
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| Abstract: | IntroductionThe purpose of the present study was to investigate the association of smoking with biochemical recurrence (BCR) and metastasis in radiation-recurrent prostate cancer (PCa) patients undergoing salvage radical prostatectomy (SRP).Patients and MethodsA total of 214 patients treated with SRP for radiation-recurrent PCa in 5 tertiary referral centers were included from January 2007 to December 2015. Kaplan-Meier analyses were used to assess the time to BCR and metastasis. Pre- and postoperative multivariable Cox proportional hazard regression models were fitted.ResultsOverall, 120 (56.1%), 49 (22.9%), and 45 (21%) patients were never, former, and current smokers, respectively. Low-, medium-, and high-cumulative smoking exposure was registered in 59.8%, 16.4%, and 23.8% of cases, respectively. Patients with high cumulative smoking exposure had a significantly greater rate of a pathologic Gleason score of ≥ 8 (P = .01) and extracapsular extension (P = .004). Smoking status, cumulative smoking exposure, intensity, and duration were significantly associated with BCR-free survival (P < .001 for all). Smoking status, cumulative smoking exposure, and smoking intensity were significantly associated with metastasis-free survival (P = .03 for all). High cumulative smoking exposure was independently associated with BCR in both pre- (hazard ratio, 2.23; P = .001) and postoperative (hazard ratio, 1.64; P = .04) multivariable models adjusted for the effects of established clinicopathologic features. Smoking cessation did not affect either BCR- or metastasis-free survival (P = .56 and P = .40, respectively).ConclusionHigh cumulative smoking exposure was associated with the biologic and clinical aggressiveness of PCa in patients treated with SRP for radiation-recurrent disease. Smoking is a modifiable risk factor that detrimentally affected the outcomes, even in patients with advanced PCa. |
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| Keywords: | Cumulative exposure Dose relationship Radiation-recurrent prostate cancer Salvage radical prostatectomy Smoking |
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