BJUI：吸烟可诱发尿路上皮瘤

　　近日发表在《英国国际泌尿学杂志》上的一项研究显示，吸烟会大大增加人们尤其是女性患严重尿路上皮瘤的风险，其死亡风险也会因为吸烟而出现上升。尽管性别差异背后的生物学机制尚不清楚，研究还是表明医务人员与社会大众应切实做好预防吸烟与戒烟方面的工作，帮助人们特别是女性积极预防膀胱癌、输卵管癌和肾癌等致命性癌症。

　　为了评估吸烟习惯的性别影响以及长期吸烟对尿路上皮瘤患者健康造成的影响，以康奈尔大学威尔医学院博士Shahrokh Shariat为首的研究人员对来自5家国际机构的864名患者进行了研究，其中553名为男性，311名为女性，这些患者都接受了尿路上皮瘤手术治疗。

　　研究发现，与男性吸烟者相比，女性吸烟者更容易出现癌症复发；对于长期重度吸烟的女性患者，其癌症复发率与死亡率分别比男性患者的高出70%和100%;而吸烟的轻重、持续时间以及积累程度仅在女性患者中与癌症复发和死亡有联系；对于戒烟超过10年的患者来说，无论是女性还是男性，其死于癌症的风险会回归到非吸烟者的风险水平。

　　Shariat博士表示：“吸烟的生物学和临床影响似乎在女性和男性中表现不同，对此人们需要进行更多的研究来探索这一差异的原因，此外，针对不同性别的预防吸烟和戒烟行为将会对尿路上皮瘤产生重大的影响。”

Gender-specific effect of smoking on upper tract urothelial carcinoma outcomes

Objective

To evaluate the gender-specific differential effects of smoking habits and cumulative smoking exposure on outcomes in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).

Patients and Methods

A total of 864 consecutive patients, comprising 553 (64%) men and 311 (36%) women, from five international institutions underwent RNU without neoadjuvant chemotherapy.

Smoking history included smoking status (current, former or never), quantity of cigarettes per day (CPD), smoking duration in years and years since smoking cessation. Cumulative smoking exposure was categorized as light short-term (≤19 CPD and ≤19.9 years), moderate (all combinations except light short-term and heavy long-term), and heavy long-term (≥20 CPD and ≥20 years).

Uni- and multivariable competing risk regression models were used to assess the associations with outcomes.

Results

Overall, 244 (28.2%), 297 (34.4%) and 323 (37.4%) patients were never, former and current smokers, respectively.

There were no differences in smoking status, quantity and duration between the genders.

In female ever smokers, 30 (9.6%), 121 (38.9%) and 67 (21.5%) were light short-term, moderate and heavy long-term smokers, respectively. Compared with men, female current smokers were more likely to experience disease recurrence in univariable analysis (P = 0.013).

In heavy long-term smokers, female gender was significantly associated with disease recurrence (hazard ratio [HR] 1.7; P = 0.03) and cancer-specific mortality (HR 2.0; P = 0.009) in multivariable analysis that adjusted for standard clinico-pathological features.

In female patients only, smoking quantity, duration and cumulative exposure were associated with disease recurrence and cancer-specific mortality on multivariable analyses (P ≤ 0.025).

Conclusions

The impact of smoking on UTUC outcomes after RNU is gender-specific.

Females who are current and heavy long-term smokers experience worse outcomes than their male counterparts.

Further research is needed to elucidate the molecular mechanisms underlying the gender-specific differential effect of smoking on UTUC outcomes.