NEW ORLEANSIn women with locally advanced cervical cancer, smoking is an independent risk factor for a significantly worse outcome, a new study from the Gynecologic Oncology Group (GOG) has shown.
Smoking has previously been shown to be an independent risk factor for squamous cell carcinoma of the cervix. About 50% of North American women who develop cervical cancer, in fact, are smokers. The present study takes this finding a step further, showing that smoking also affects survival.
In GOG 165, reported at the 34th Annual Meeting of the Society for Gynecologic Oncologists (abstract 71), 315 patients with stage IIb, IIIb, and IVa cervical cancer were randomized to two different treatment arms from 1977 to 2000 and followed for a median of 31.5 months. GOG 165 compared the effectiveness of cisplatin(Drug information on cisplatin) (Platinol)-based chemoradia-tion vs chemoradiation using prolonged venous infusion of fluorouracil(Drug information on fluorouracil) (5-FU). The duration of radiotherapy was similar for the two groups, and gastrointestinal toxicity was also similar.
Prior to beginning chemoradiation therapy, patients completed a questionnaire pertaining to past and current smoking behavior. Subjects were considered smokers if they were currently smoking one or more cigarettes per week. Smoking status was confirmed by urinary cotinine analysis, with a level of 100 ng/mL or greater being considered indicative of smoking. Self-reported smoking and urinary cotinine results had 94.4% agreement. Of the 315 patients, 42% were current smokers. Current smoking status was associated with younger age, higher stage of disease, and squamous histology.
The study found a 44% increased risk of disease progression and a 59% increase in the relative risk of death among current smokers, reported Steven E. Waggoner, MD, of Case Western Reserve University, Cleveland.