Smoking and Disease Outcomes in Patients With Malignant Germ Cell Tumors

Electronic medical records of 1161 patients with germ cell tumor (GCT) at Dana-Farber Cancer Institute were used to evaluate the association between smoking and GCT presentation and outcomes. Smoking was associated with more advanced disease at diagnosis and poorer GCT outcomes, including increased risk of relapse. Background: To our knowledge, no studies have evaluated the association between smoking and stage at diagnosis or survival among men with germ cell tumors (GCTs). We therefore evaluated the association between smoking and GCT presentation and outcomes. Methods: Electronic medical records of 1161 patients with GCT treated at Dana-Farber Cancer Institute between 1997 and 2013 were reviewed. Outcomes of interest were stage at diagnosis, relapse from clinical stage I (CSI) disease, relapse after first-line chemotherapy, and death from disease. Logistic regression models evaluated the association between smoking and tumor characteristics at diagnosis. Multivariable Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between smoking at diagnosis and risk of relapse and GCT cancer death. Results: In men diagnosed with CSI disease, smokers were 86% more likely to have a large tumor (≥ 4 cm) compared with nonsmokers (odds ratio [OR] 1.86; 95% CI, 1.28-2.71) and had a statistically significant increased risk of relapse (HR 2.05; 95% CI, 1.41-2.97). Among men with metastatic disease at diagnosis, the heaviest smokers (> 15 pack-years) were more likely to present with intermediate- or poor-risk disease compared with nonsmokers (OR 3.12; 95% CI, 1.29-7.55) and any smoking was associated with a statistically significant increased risk of relapse (HR 1.86; 95% CI, 1.26-2.73) and GCT death (HR 2.56; 95% CI, 1.55-4.23). Conclusion: Smoking is associated with more advanced disease at diagnosis and poorer GCT outcomes, including increased risk of relapse, for both CSI and metastatic disease.