title: Smoking and alcohol use may be risk factors for poorer outcome in patients with clear cell renal carcinoma.
abstract: OBJECTIVE
  To correlate the clinical outcomes of 148 patients with clear cell renal carcinoma treated at a single institution with a variety of other factors.
  
  
  METHODS
  Cases were derived from a consecutive series of nephrectomy specimens obtained from 1980 to 1994. A retrospective review of clinical records was performed, with tobacco use, alcohol use, recurrence, and survival noted.
  
  
  RESULTS
  The median age of the patients was 62 years. The median follow-up was 4.4 years. Of 148 patients, 82% had localized disease (MO), and 18% had suspected metastases (M1) at the time of nephrectomy. Of 121 patients without metastases at diagnosis, T classification was assessed for 117: 48 (41%) had T1 disease, 18 (15%) T2, 46 (39%) T3, and 5 (4%) T4. The Fuhrman grade was 1 or 2 in 51% of patients and 3 or 4 in 45%. Both clinical stage and grade were significantly associated with overall survival (P <0.0001 and P = 0.0028, respectively) and recurrence-free survival (P = 0.0002 and P = 0.0011, respectively). Smoking and alcohol use history was determined in 70% and 63% of patients, respectively. In patients with Stage M0, smokers had a significantly worse overall survival rate compared with nonsmokers (P = 0.039). Also, in patients with Stage M0, a trend toward a worse recurrence-free survival rate was noted in alcohol users compared with those who never used alcohol regularly (P = 0.06).
  
  
  CONCLUSIONS
  The prognosis of clear cell renal carcinoma depends on the pathologic stage at diagnosis and the Fuhrman grade. Smoking is a known risk factor for developing renal cancer and may be associated with increased mortality from clear cell carcinoma in patients with Stage M0. Also, regular alcohol use may decrease the recurrence-free survival rate.
authors.affiliation: Lank Center for Genitourinary Oncology, Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts 02115, USA.
authors.forename: W K
authors.initials: WK
authors.lastname: Oh
authors.forename: J
authors.initials: J
authors.lastname: Manola
authors.forename: A A
authors.initials: AA
authors.lastname: Renshaw
authors.forename: D
authors.initials: D
authors.lastname: Brodkin
authors.forename: K R
authors.initials: KR
authors.lastname: Loughlin
authors.forename: J P
authors.initials: JP
authors.lastname: Richie
authors.forename: C L
authors.initials: CL
authors.lastname: Shapiro
authors.forename: P W
authors.initials: PW
authors.lastname: Kantoff
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D016896:Treatment Outcome