Oncologic Effect of Cumulative Smoking Exposure in Patients Treated With Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer - Beyond the Abstract
Overall, 214 patients treated with open SRP and pelvic lymph node dissection after brachytherapy, EBRT, intensity-modulated RT or hybrid techniques were analyzed. In our series, SRP seems to be a safe procedure with a 4.2% and 13% of intra- and post-operative complications, respectively. We found that cumulative smoking exposure was not associated with the rate of intra- or postoperative complications. In a recent overview of over 22,000 patients treated with RP, current smokers had a higher rate of overall complication reaching the limit of significance and current smoking status was an independent predictor of unplanned intubation [5]. Smoking-related postoperative complications have been shown to drive significant hospital care expenditures in general surgery with emerging evidence that perioperative smoking cessation interventions leading to short-term cost savings and improvement in long-term health. Our cohort may have been too small to detect such an association [6]. In addition, all patients were treated at expert centers with an advanced selection process with standardized postoperative pathways. Finally, patients selected for SRP undergo stringent criteria being younger and healthier, in general, than the average radiation-recurrent PCa patient.
This is the first study, to our knowledge, to report the clinical impact of tobacco habit on oncologic outcomes in men treated with SRP for radiation-recurrent PCa. We found that patients with a high cumulative smoking exposure (≥ 20 cigarettes-per-day for ≥ 20 years) resulted to be significantly associated with a worse pathologic Gleason score and extracapsular disease. Furthermore, at Kaplan-Meier survival curves, the current smoking status at surgery and the high cumulative smoking exposure were significantly associated with BCR-free and metastasis-free survival. The high smoking exposure was an independent predictor of BCR at preoperative and postoperative Cox regression models, which adjusted for the effects of well-known clinical and pathological features.
Written by:
Andrea Mari, Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
Shahrokh F. Shariat, Adjunct Professor of Urology and Medical Oncology, Weill Medical College of Cornell University, New York, NY, USA, Adjunct Professor of Urology, UT Southwestern, Dallas, TX, USA
References
1. Secretan B, Straif K, Baan R, et al (2009) A review of human carcinogens--Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol 10:1033–1034.
2. Islami F, Moreira DM, Boffetta P, Freedland SJ (2014) A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. Eur Urol 66:1054–1064. doi: 10.1016/j.eururo.2014.08.059
3. Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E (2011) Smoking and Prostate Cancer Survival and Recurrence. JAMA 305:2548–2555. doi: 10.1001/jama.2011.879
4. Steinberger E, Kollmeier M, McBride S, et al (2015) Cigarette smoking during external beam radiation therapy for prostate cancer is associated with an increased risk of prostate cancer-specific mortality and treatment-related toxicity. BJU Int 116:596–603. doi: 10.1111/bju.12969
5. Byun DJ, Cohn MR, Patel SN, et al (2017) The Effect of Smoking on 30-Day Complications Following Radical Prostatectomy. Clin Genitourin Cancer 15:e249–e253. doi: 10.1016/j.clgc.2016.08.002
6. Kamath AS, Vaughan Sarrazin M, Vander Weg MW, et al (2012) Hospital costs associated with smoking in veterans undergoing general surgery. J Am Coll Surg 214:901–8.e1. doi: 10.1016/j.jamcollsurg.2012.01.056
Read the Abstract