title: Does active smoking induce hematogenous metastatic spread in colon cancer?
abstract: BACKGROUND
  No consensus exists on the influence of active smoking on the baseline staging of colon cancer patients.
  
  
  METHODS
  A cohort of colon cancer patients treated surgically at Massachusetts General Hospital (2004 to 2011) was reviewed.
  
  
  RESULTS
  Of 1,071 patients, 563 reported ever smoking, among which 128 (12%) patients were current smokers. Ex-smokers and never smokers had similar rates of nodal (relative risk [RR] .9, P = .19) and metastatic disease (RR .96, P = .72), leading to comparable colon cancer-related mortality (RR 1.01, P = .95). Current smokers had similar rates of lymph node disease (RR 1.01, P = .88), but had significantly higher stage-adjusted odds of metastatic disease at presentation (odds ratio 2.57, 95% confidence interval 1.36 to 4.98, P = .005), in addition to higher stage-adjusted all-cause mortality (hazard ratio 1.44, P = .017).
  
  
  CONCLUSIONS
  Active smoking was a stage-independent risk factor for baseline hematogenous metastasis and mortality. As this link was not present in former smokers, a potential healthcare benefit may be achieved in terms of baseline colon cancer presentation and outcomes through smoking cessation.
authors.affiliation: Department of Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street 02114, Boston, MA, USA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Amri
authors.affiliation: Department of Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street 02114, Boston, MA, USA.
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Bordeianou
authors.affiliation: Department of Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street 02114, Boston, MA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.affiliation: Department of Surgery, Harvard Medical School and Massachusetts General Hospital, 15 Parkman Street 02114, Boston, MA, USA. Electronic address: dberger@mgh.harvard.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000368:Aged; D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*
keywords: Active smoking; Baseline metastasis; Colon cancer; Current smoking; Hematogenous metastasis; Mortality