TY - JOUR
T1 - Association between cigarette smoking and prognosis in locally advanced cervical carcinoma treated with chemoradiation
T2 - A Gynecologic Oncology Group study
AU - Waggoner, Steven E.
AU - Darcy, Kathleen M.
AU - Fuhrman, Barbara
AU - Parham, Groesbeck
AU - Lucci, Joseph
AU - Monk, Bradley J.
AU - Moore, David H.
N1 - Funding Information:
This study was supported by National Cancer Institute grants to the Gynecologic Oncology Group (GOG) Administrative Office (CA 27469), the GOG Statistical and Data Center (CA 37517) and the Institute for Cancer Prevention (CA 70972). The following GOG member institutions participated in this study: University of Alabama at Birmingham, Duke University Medical Center, Abington Memorial Hospital, University of Rochester Medical Center, Walter Reed Army Medical Center, Wayne State University, University of Southern California, University of Mississippi Medical Center, Colorado Gynecologic Oncology Group, P.C., University of California at Los Angeles, University of Washington, University of Pennsylvania Cancer Center, Milton S. Hershey Medical Center, University of Cincinnati, University of North Carolina School of Medicine, University of Iowa Hospitals and Clinics, University of Texas Southwestern Medical Center at Dallas, Indiana University Medical Center, Wake Forest University School of Medicine, University of California Medical Center at Irvine, Rush-Presbyterian-St. Luke's Medical Center, SUNY Downstate Medical Center, University of Kentucky, Community Clinical Oncology Program, The Cleveland Clinic Foundation, SUNY at Stony Brook, Eastern Pennsylvania GYN/ONC Center, P.C., Washington University School of Medicine, Columbus Cancer Council, University of Massachusetts Medical School, Fox Chase Cancer Center, Medical University of South Carolina, Women's Cancer Center, University of Oklahoma, University of Virginia, University of Chicago, Tacoma General Hospital, Mayo Clinic, Case Western Reserve University, Tampa Bay Cancer Consortium, North Shore University Hospital and Brookview Research, Inc. In addition to providing financial support, the sponsoring agency (National Cancer Institute) approved the study design and a representative of that agency regularly monitored the progress of the study including patient accrual, study conduct and the collection and analysis of patient data. Authors (SW, KD) had full access to all the study data and take public responsibility for the integrity of the data and the accuracy of the data analysis. The authors thank Drs. Jianmin Wang and Brian Bundy for reviewing the statistical analyses performed for this study. Special acknowledgements also go to Drs. Rachelle Lanciano, Alison Calkins, Frederick Stehman, Dennis O'Connor, Daniel Petereit and J. Tate Thigpen for their work on this phase III treatment trial and to Barbara Saczynski for coordinating the clinical data. We also thank Caron Modeas for assistance in preparing and editing the manuscript, Dr. Zoe Miner for conducting a thorough critique and providing helpful comments and the GOG Publications Subcommittee for its thoughtful recommendations.
PY - 2006/12
Y1 - 2006/12
N2 - Objective.: To determine if smoking, a known risk factor for a number of cancers including cervical cancer, is associated with poor prognosis in patients with locally advanced cervical carcinoma treated with chemoradiation. Methods.: Patients with primary, previously untreated, histologically confirmed stage II-B, III-B or IV-A cervical carcinoma participated in a Gynecologic Oncology Group (GOG) phase III study (GOG 165) and were randomly allocated to receive radiation plus either cisplatin or 5-fluorouracil. Smoking behavior was ascertained using an administered questionnaire and by quantifying urine cotinine concentration. Disease progression was defined as a ≥ 50% increase in the cross product of the existing tumor compared with previous assessments. Patients were followed until death. Results.: Of 328 enrolled patients, 12 were ineligible, one was inevaluable for reported smoking status and 40 others were inevaluable for cotinine-derived smoking status. Among evaluable patients, 133 (42%) were reported smokers and 111 (40%) were cotinine-derived smokers. The kappa for agreement between the groups was 0.872 (P < 0.01). Compared with non-smokers, median survival was 15 months shorter for reported smokers and 20 months shorter for cotinine-derived smokers (P < 0.01). After adjusting for covariates, a significant increase in the risk of death (but not disease progression) was observed for reported smokers (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: 1.01-2.27; P = 0.04) and cotinine-derived smokers (HR: 1.57; 95% CI: 1.03-2.38; P = 0.04). Conclusions.: Smoking predicts worse overall survival in women with locally advanced cervical carcinoma treated with chemoradiation.
AB - Objective.: To determine if smoking, a known risk factor for a number of cancers including cervical cancer, is associated with poor prognosis in patients with locally advanced cervical carcinoma treated with chemoradiation. Methods.: Patients with primary, previously untreated, histologically confirmed stage II-B, III-B or IV-A cervical carcinoma participated in a Gynecologic Oncology Group (GOG) phase III study (GOG 165) and were randomly allocated to receive radiation plus either cisplatin or 5-fluorouracil. Smoking behavior was ascertained using an administered questionnaire and by quantifying urine cotinine concentration. Disease progression was defined as a ≥ 50% increase in the cross product of the existing tumor compared with previous assessments. Patients were followed until death. Results.: Of 328 enrolled patients, 12 were ineligible, one was inevaluable for reported smoking status and 40 others were inevaluable for cotinine-derived smoking status. Among evaluable patients, 133 (42%) were reported smokers and 111 (40%) were cotinine-derived smokers. The kappa for agreement between the groups was 0.872 (P < 0.01). Compared with non-smokers, median survival was 15 months shorter for reported smokers and 20 months shorter for cotinine-derived smokers (P < 0.01). After adjusting for covariates, a significant increase in the risk of death (but not disease progression) was observed for reported smokers (hazard ratio [HR]: 1.51; 95% confidence interval [CI]: 1.01-2.27; P = 0.04) and cotinine-derived smokers (HR: 1.57; 95% CI: 1.03-2.38; P = 0.04). Conclusions.: Smoking predicts worse overall survival in women with locally advanced cervical carcinoma treated with chemoradiation.
KW - Cervical carcinoma
KW - Prognosis
KW - Smoking
KW - Urine cotinine concentration
UR - http://www.scopus.com/inward/record.url?scp=33751414313&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2006.05.017
DO - 10.1016/j.ygyno.2006.05.017
M3 - Article
C2 - 16815535
AN - SCOPUS:33751414313
SN - 0090-8258
VL - 103
SP - 853
EP - 858
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -