Smoking Worsens Survival Rates in Upper Tract Urothelial Carcinoma Patients, suggests study

A recent study revealed a direct correlation between cumulative smoking exposure (CSE) and poorer oncologic outcomes in patients undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). The findings from a comprehensive review of 1,041 patients across 17 medical institutions, brought out the detrimental impact of smoking on both cancer-specific survival (CSS) and overall survival (OS).

The study included a total patient pool of 1,730 but focused on the patients with complete pathological and smoking history, categorized smoking exposure into 3 levels as light, moderate, and heavy, based on the number of cigarettes smoked per day and the duration of smoking. Light smoking exposure was defined as a median of 2.0 pack-years, moderate exposure as 13.0 pack-years, and heavy exposure as 40.0 pack-years.

The data showed that the greater the smoking exposure, the worse the survival outcomes. The patients who had never smoked demonstrated the highest 5-year cancer-specific survival (CSS) at 97% and an overall survival (OS) rate of 91%. When compared, Light smokers (2.0 pack-years) had a 5-year CSS of 96% and OS of 89%, Moderate smokers (13.0 pack-years) faced these figures drop to 85% for CSS and 66% for OS and Heavy smokers (40.0 pack-years) had the poorest outcomes, with a 5-year CSS of 75% and OS of 60%.

The research used advanced statistical models to confirm the association between smoking exposure and decreased survival. Both moderate and heavy smoking exposure were independently linked to worse outcomes, even after adjusting for other potential confounding factors. The study found that smoking cessation did not significantly improve survival rates in patients with moderate or heavy smoking exposure. This suggests that after a certain threshold of cumulative smoking, the damage to overall and cancer-specific survival may be irreversible.

This study emphasized the importance of early smoking cessation to prevent the long-term oncologic consequences seen in UTUC patients. Given the aggressive nature of UTUC and the clear link between smoking and worse health outcomes, these outcomes reinforce the need for both preventive measures and continued, aggressive cancer management. Overall, this study highlights that while quitting smoking is beneficial, the earlier patients stop, the better their long-term cancer outcomes. 

Reference:

Bhanvadia, R., Bochner, E., Popokh, B., Taylor, J., Franco, A., Wu, Z., Antonelli, A., Ditonno, F., Abdollah, F., Simone, G., Tuderti, G., Correa, A., Ferro, M., Tozzi, M., Porpiglia, F., Tufano, A., Perdonà, S., Broenimann, S., Singla, N., … Margulis, V. (2025). Cumulative smoking exposure impacts oncologic outcomes of upper tract urothelial carcinoma. Urologic Oncology. https://doi.org/10.1016/j.urolonc.2025.01.018