title: Tobacco smoking and risk of recurrence for squamous cell cancer of the anus.
abstract: OBJECTIVE
  Squamous cell cancer of the anus is associated with multiple risk factors, including infection with human papillomavirus, immunosuppression, chronic inflammation, and tobacco smoking, although there is little data on these factors for the prediction of recurrent disease. Here, we evaluated the risk of recurrence and mortality of anal carcinoma in association with tobacco smoking.
  
  
  METHODS
  We conducted a retrospective review of cases of anal carcinoma from two local hospitals. We obtained information on treatment response and cancer recurrence, as well as tobacco usage from medical records.
  
  
  RESULTS
  We identified 64 patients with squamous cell cancer of the anus, and 34 of these (53%) had a tobacco smoking history. Current smokers had higher carcinoma recurrence rates (11/34, 32%) than non-smokers (6/30, 20%). Overall mortality was 33% (21/64), and cancer-related mortality was 23% (15/64). Smokers were more likely to die from recurrence than non-smokers, with 45% of smokers dead compared to only 20% of non-smokers by 5 years after treatment.
  
  
  CONCLUSIONS
  Tobacco smoking appears to be associated with anal carcinoma disease recurrence, and is related to increased mortality. This data suggests that patients should be cautioned about tobacco smoking once a diagnosis of anal carcinoma is made in attempt to improve their long-term outcome.
authors.affiliation: Department of Surgery, University of California, San Diego, CA 92093-0063, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ramamoorthy
authors.forename: Linda
authors.initials: L
authors.lastname: Luo
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Luo
authors.forename: John M
authors.initials: JM
authors.lastname: Carethers
mesh_terms: D001005:Anus Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000139:chemically induced / Q000453:epidemiology* / Q000473:pathology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013995:Time