Institute of Urologic Oncology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California 90095-7207, USA.
Cancer. 2012 Apr 1;118(7):1795-802. doi: 10.1002/cncr.26453. Epub 2011 Aug 25.
Tobacco use is a leading cause of premature death, yet few studies have investigated the effect of tobacco exposure on the outcome of patients with renal cell carcinoma (RCC). The authors of this report retrospectively studied the impact of smoking on clinicopathologic factors, survival outcomes, and p53 expression status in a large cohort of patients with RCC.
Eight hundred-two patients (457 nonsmokers and 345 smokers) who had up to 232 months of follow-up were compared for differences in their clinicopathologic features and survival outcomes. Immunohistochemical differences in p53 expression were correlated with smoking status.
Smokers presented more commonly with pulmonary comorbidities (P < .0001) and cardiac comorbidities (P = .014) and with a worse performance status (P = .031) than nonsmokers. Smoking was associated significantly with tumor multifocality (P = .022), higher pathologic tumor classification (P = .037), an increased risk of bulky lymph node metastases (P = .031), and the presence of distant metastases (P < .0001), especially lung metastases (P < .0001). Both overall survival (OS) (62.37 months vs 43.64 months; P = .001) and cancer-specific survival (CSS) (87.43 months vs 56.57 months; P = .005) were significantly worse in patients who smoked. The number of pack-years was retained as an independent predictor of CSS and OS in patients with nonmetastatic disease. Mean expression levels of p53 were significantly higher in current smokers compared with former smokers and nonsmokers (P = .012).
In patients with RCC, a history of smoking was associated with worse pathologic features and survival outcomes and with an increased risk of having mutated p53. Further investigation of the genetic and molecular mechanisms associated with decreased CSS in patients with RCC who have a history of smoking is indicated.
吸烟是导致早逝的主要原因之一，但很少有研究调查烟草暴露对肾细胞癌（RCC）患者结局的影响。本文作者回顾性研究了吸烟对大量 RCC 患者的临床病理因素、生存结局和 p53 表达状态的影响。
对 802 例患者（457 名不吸烟者和 345 名吸烟者）进行比较，分析他们的临床病理特征和生存结局的差异。比较 p53 表达的免疫组织化学差异与吸烟状态的关系。
与不吸烟者相比，吸烟者更常见肺部合并症（P <.0001）和心脏合并症（P =.014）以及较差的体能状态（P =.031）。与不吸烟者相比，吸烟与肿瘤多灶性（P =.022）、更高的病理肿瘤分级（P =.037）、大体积淋巴结转移的风险增加（P =.031）和远处转移的发生（P <.0001）显著相关，尤其是肺转移（P <.0001）。吸烟患者的总生存（OS）（62.37 个月比 43.64 个月；P =.001）和癌症特异性生存（CSS）（87.43 个月比 56.57 个月；P =.005）均显著更差。非转移性疾病患者中，吸烟包年数是 CSS 和 OS 的独立预测因子。与前吸烟者和不吸烟者相比，现吸烟者 p53 的平均表达水平明显更高（P =.012）。
在 RCC 患者中，吸烟史与更差的病理特征和生存结局相关，并增加了 p53 突变的风险。需要进一步研究吸烟史与 RCC 患者 CSS 降低相关的遗传和分子机制。
