title: Smoking negatively impacts renal cell carcinoma overall and cancer-specific survival.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Institute of Urologic Oncology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California 90095-7207, USA.
authors: Nils
authors: N
authors: Kroeger
authors: Tobias
authors: T
authors: Klatte
authors: Frédéric D
authors: FD
authors: Birkhäuser
authors: Edward N
authors: EN
authors: Rampersaud
authors: David B
authors: DB
authors: Seligson
authors: Nazy
authors: N
authors: Zomorodian
authors: Fairooz F
authors: FF
authors: Kabbinavar
authors: Arie S
authors: AS
authors: Belldegrun
authors: Allan J
authors: AJ
authors: Pantuck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology / Q000556:secondary; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects*; D016019:Survival Analysis