吸烟作为肾细胞癌组织学亚型危险因素的比较分析。

Comparative Analysis of Smoking as a Risk Factor among Renal Cell Carcinoma Histological Subtypes.

机构信息

Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.

Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York.

出版信息

J Urol. 2015 Sep;194(3):640-6. doi: 10.1016/j.juro.2015.03.125. Epub 2015 Apr 18.

DOI:10.1016/j.juro.2015.03.125

PMID:25896558

Abstract

PURPOSE

Smoking is the best established modifiable risk factor for renal cell carcinoma. However, the risks of individual renal cell carcinoma histological subtypes are unknown. Therefore, we investigated the relationship between smoking and renal cell carcinoma subtype.

MATERIALS AND METHODS

Cigarette smoking data were prospectively collected from 816 consecutive patients with nonfamilial renal cell carcinoma (705) or benign pathology (111) undergoing nephrectomy at a single National Comprehensive Cancer Network® cancer center, and were retrospectively tested for an association with histological diagnosis on univariable and propensity adjusted analyses.

RESULTS

Smoking was reported by 51% of patients, including 21% active smokers and 30% former smokers. Active smoking was more common with clear cell (23%) or papillary (26%) renal cell carcinoma than benign histology (14%, p <0.05 each), yet strikingly less common with chromophobe renal cell carcinoma (6%, p <0.05 vs clear cell or papillary). Any smoking history (active or former) was also relatively uncommon with chromophobe (26%) vs clear cell (53%, p = 0.003) or papillary (58%, p = 0.001) histology. Smoking extent based on mean pack-years was significantly greater with clear cell (15.3 mean pack-years) or papillary (15.2 mean pack-years) renal cell carcinoma but not chromophobe renal cell carcinoma (9.4 mean pack-years) compared to benign histology (9.4 mean pack-years, p ≤0.05, p <0.05, p = 1.0, respectively). On propensity analyses adjusting for multiple variables, clear cell (OR 2.2, p <0.05) and papillary (OR 2.4, p <0.05) histologies but not chromophobe histology remained independently associated with active smoking.

CONCLUSIONS

Traditional understanding of smoking as a renal cell carcinoma risk factor applies to clear cell and papillary renal cell carcinoma but not the chromophobe subtype. These findings underscore distinct carcinogenic mechanisms underlying the various renal cell carcinoma subtypes.

摘要

目的

吸烟是可改变的肾癌最强风险因素。然而，个体肾癌组织学亚型的风险尚不清楚。因此，我们研究了吸烟与肾癌亚型之间的关系。

材料与方法

前瞻性收集了 816 例非家族性肾癌（705 例）或良性病变（111 例）患者的吸烟数据，这些患者在单一的美国国家综合癌症网络®癌症中心接受了肾切除术，在单变量和倾向调整分析中对这些数据进行了与组织学诊断相关的回顾性测试。

结果

51%的患者报告有吸烟史，其中 21%为现吸烟者，30%为既往吸烟者。与良性组织学相比，透明细胞（23%）或乳头状（26%）肾癌患者的现吸烟更为常见（p<0.05），而与嫌色细胞肾癌（6%）相比则明显较少（p<0.05）。任何吸烟史（现吸烟或既往吸烟）在嫌色细胞癌中也相对少见（26%），而在透明细胞癌（53%，p=0.003）或乳头状癌（58%，p=0.001）中则更为常见。根据平均包年数计算的吸烟量与透明细胞（15.3 平均包年）或乳头状（15.2 平均包年）肾癌相比显著更大，但与嫌色细胞肾癌（9.4 平均包年）相比则无显著差异（与良性组织学相比，9.4 平均包年，p≤0.05，p<0.05，p=1.0）。在调整多个变量的倾向分析中，透明细胞（OR 2.2，p<0.05）和乳头状（OR 2.4，p<0.05）组织学，而非嫌色细胞组织学，与现吸烟仍然独立相关。