More advanced-stage tumors among smokers with endometrial cancer

To determine whether endometrial cancer is unusually aggressive in smokers, smokers were compared with nonsmokers among 157 women who had undergone hysterectomy for these tumors between 1979 and 1988. The following factors were analyzed: tumor stage and grade, duration of tumor-related symptoms, host age, degree of obesity, use of estrogen supplementation, and smoking habits. Multivariate analysis indicated that women with advanced-stage disease (stages II-IV) more often had been smokers than women with early-stage disease (stages 0-I; 12 of 30 [40%] versus 14 of 127 [11%], respectively; odds ratio, 5.38; confidence interval, 2.23-11.31). Smokers and nonsmokers were similar in age, parity, degree of obesity, use of estrogen supplementation, tumor grade, and duration of symptoms. Advanced-stage disease also was associated with a high tumor grade (odds ratio, 3.16). Among women with early-stage tumors, a trend toward more frequent myometrial invasion in smokers was not significant by conventional criteria. These observations apparently reflect a smoking-related decrease in the incidence of early-stage tumors, plus smoking-related increases in tumor invasiveness and metastasis.