For patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), the impact of smoking is gender specific, with worse outcomes for females than for males, according to a study published online ahead of print in BJU International.

Michael Rink, MD, from the New York-Presbyterian Hospital in New York City, and colleagues examined the gender-specific effects of smoking habits and smoking exposure on outcomes in 864 patients (64% male) from five institutions who underwent RNU for UTUC.

Of the cohort, 28.2% were never smokers; 34.4% were former smokers; and 37.4% were current smokers. In univariate analysis, the researchers found that female smokers were significantly more likely to experience disease recurrence compared with men. After adjustment for standard clinico-pathological features, among heavy long-term smokers, female gender was associated with a 70% increased likelihood of disease recurrence and twofold increased risk of cancer-specific mortality. In multivariate analyses, smoking quantity, duration, and cumulative exposure correlated with disease recurrence and cancer-specific mortality for females only.

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“Females who are current smokers and have a heavy long-term cumulative smoking exposure are significantly more likely to experience disease recurrence and cancer-specific mortality than their male counterparts,” the authors wrote. “The biological mechanisms underlying the gender-specific differential effect of smoking need to be investigated further.”