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Smokers With Cervix Cancer Have More Uterine Corpus Invasive Disease and an Increased Risk of Recurrence After Treatment With Chemoradiation

Mileshkin, Linda MD, FRACP*†; Paramanathan, Ashvin MBBS; Kondalsamy-Chennakesavan, Srinivas MBBS, MPH; Bernshaw, David FRANZCR*; Khaw, Pearly FRANZCR*; Narayan, Kailash PhD, FRANZCR*†

International Journal of Gynecological Cancer: September 2014 - Volume 24 - Issue 7 - p 1286–1291
doi: 10.1097/IGC.0000000000000170
Cervical Cancer

Background Smoking is a risk factor for cervix cancer and causes hypoxemia, which promotes tumor infiltration and potentially impacts on treatment outcome. We performed a retrospective study to determine if smokers had an increased risk of uterine corpus infiltration, which is associated with more advanced disease and/or treatment failure after primary chemoradiation.

Methods Results from a prospective database of patients treated with primary chemoradiation for locally advanced cervix cancer with a pretreatment MRI were analyzed. Smoking status was assessed by self-report at presentation.

Results Smoking status was recorded for 346 of the 362 patients with 98 current smokers (28%), 56 ex-smokers (16%), and 192 nonsmokers (55%). Median age was 58 years with ever-smokers having a younger age at diagnosis than nonsmokers. Histologic type, International Federation of Gynecology and Obstetrics stage, tumor volume, and nodal involvement were similar across groups, as were toxicities of treatment. Ever-smokers were more likely to have corpus uterine invasion than nonsmokers. Ever-smokers had more recurrences than nonsmokers, with nonsmokers having a longer median overall survival (50.1 vs 38.7 months, P = 0.004) and relapse-free survival (46.8 vs 28.5 months, P = 0.003). In multifactor analysis, ever-smoking status was a significant predictor of developing corpus invasive disease and of inferior relapse-free and overall survival after treatment.

Conclusions Smokers have a greater risk for developing corpus invasive cervix cancer. Although nonsmokers have an older age at diagnosis, they live longer and have fewer recurrences after a diagnosis of locally advanced carcinoma of the cervix.

*Peter MacCallum Cancer Centre, Victoria, Australia; †The University of Melbourne, Victoria, Australia; and ‡Rural Clinical School, The University of Queensland, Australia.

Address correspondence and reprint requests to Linda Mileshkin, MD, FRACP, Peter MacCallum Cancer Centre, St Andrews Place East, Melbourne, Victoria, Australia 3002. E-mail:

The authors declare no conflicts of interest.

Received January 9, 2014

Received in revised form April 1, 2014

Accepted April 9, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.