title: Smokers with cervix cancer have more uterine corpus invasive disease and an increased risk of recurrence after treatment with chemoradiation.
abstract: BACKGROUND
  Smoking is a risk factor for cervix cancer and causes hypoxemia, which promotes tumor infiltration and potentially impacts on treatment outcome. We performed a retrospective study to determine if smokers had an increased risk of uterine corpus infiltration, which is associated with more advanced disease and/or treatment failure after primary chemoradiation.
  
  
  METHODS
  Results from a prospective database of patients treated with primary chemoradiation for locally advanced cervix cancer with a pretreatment MRI were analyzed. Smoking status was assessed by self-report at presentation.
  
  
  RESULTS
  Smoking status was recorded for 346 of the 362 patients with 98 current smokers (28%), 56 ex-smokers (16%), and 192 nonsmokers (55%). Median age was 58 years with ever-smokers having a younger age at diagnosis than nonsmokers. Histologic type, International Federation of Gynecology and Obstetrics stage, tumor volume, and nodal involvement were similar across groups, as were toxicities of treatment. Ever-smokers were more likely to have corpus uterine invasion than nonsmokers. Ever-smokers had more recurrences than nonsmokers, with nonsmokers having a longer median overall survival (50.1 vs 38.7 months, P = 0.004) and relapse-free survival (46.8 vs 28.5 months, P = 0.003). In multifactor analysis, ever-smoking status was a significant predictor of developing corpus invasive disease and of inferior relapse-free and overall survival after treatment.
  
  
  CONCLUSIONS
  Smokers have a greater risk for developing corpus invasive cervix cancer. Although nonsmokers have an older age at diagnosis, they live longer and have fewer recurrences after a diagnosis of locally advanced carcinoma of the cervix.
authors.affiliation: *Peter MacCallum Cancer Centre, Victoria, Australia; †The University of Melbourne, Victoria, Australia; and ‡Rural Clinical School, The University of Queensland, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.forename: Ashvin
authors.initials: A
authors.lastname: Paramanathan
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.forename: David
authors.initials: D
authors.lastname: Bernshaw
authors.forename: Pearly
authors.initials: P
authors.lastname: Khaw
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D055815:Young Adult