Smoking-induced immune deviation contributes to progression of bladder and other cancers

Gender differences in smoking-induced changes in the tumor immune microenvironment

Both gender and smoking are correlated with prevalence and outcomes in many types of cancers. Tobacco smoke is a known carcinogen through its genotoxicity but can also affect cancer progression through its effect on the immune system. In this study, we aim to evaluate the hypothesis that the effects of smoking on the tumor immune microenvironment will be influenced differently by gender using large-scale analysis of publicly available cancer datasets. We used The Cancer Genomic Atlas (TCGA) datasets (n = 2724) to analyze effects of smoking on different cancer immune subtypes and the relative abundance of immune cell types between male and female cancer patients. We further validated our results by analyzing additional datasets, including Expression Project for Oncology (expO) bulk RNA-seq dataset (n = 1118) and single-cell RNA-seq dataset (n = 14). Results of our study indicate that in female patients, two immune subtypes, C1 and C2, are respectively over and under abundant in smokers vs. never smokers. In males, the only significant difference is underabundance of the C6 subtype in smokers. We identified gender-specific differences in the population of immune cell types between smokers and never smokers in all TCGA and expO cancer types. Increased plasma cell population was identified as the most consistent feature distinguishing smokers and never smokers, especially in current female smokers based on both TCGA and expO data. Our analysis of existing single-cell RNA-seq data further revealed that smoking differentially affects the gene expression profile of cancer patients based on the immune cell type and gender. In our analysis, female and male smokers show different smoking-induced patterns of immune cells in tumor microenvironment. Besides, our results suggest cancer tissues directly exposed to tobacco smoke undergo the most significant changes, but all other cancer types are affected as well. Findings of current study also indicate that changes in the populations of plasma cells and their correlations to survival outcomes are stronger in female current smokers, with implications for cancer immunotherapy of women smokers. In conclusion, results of this study can be used to develop personalized treatment plans for cancer patients who smoke, particularly women smokers, taking into account the unique immune cell profile of their tumors.

The Key Differences between Human Papillomavirus-Positive and -Negative Head and Neck Cancers: Biological and Clinical Implications

Head and neck squamous cell carcinoma (HNSCC) is a unique malignancy associated with two distinct risk factors: exposure to typical carcinogens and infection of human papillomavirus (HPV). HPV encodes the potent oncoproteins E6 and E7, which bypass many important oncogenic processes and result in cancer development. In contrast, HPV-negative HNSCC is developed through multiple mutations in diverse oncogenic driver genes. While the risk factors associated with HPV-positive and HPV-negative HNSCCs are discrete, HNSCC patients still show highly complex molecular signatures, immune infiltrations, and treatment responses even within the same anatomical subtypes. Here, we summarize the current understanding of biological mechanisms, treatment approaches, and clinical outcomes in comparison between HPV-positive and -negative HNSCCs.

Smoke load prognostic impact on bacillus Calmette-Guérin (BCG) treated non-muscle invasive bladder cancer

PURPOSE

Smoking habit is the major risk factor for bladder cancer (BC), related to about 50% of these tumors; however, the tobacco dose-effect impact on BC immune treatment is underexplored. This study evaluates the impact of smoke load on non-muscle invasive bladder cancer (NMIBC) prognosis after intravesical BCG.

METHODS

Smoke load, recurrence, progression and disease-specific survival were evaluated in a retrospective study including NMIBC patients treated with intravesical BCG between 2006 and 2015. Multivariate Cox regression, ROC and Kaplan-Meier curves were utilized.

RESULTS

132 pT1 NMIBC patients were included: 95 (72%) males, mean age 69.6 ± 10.5 years and mean smoking pack-years 22.0 ± 20.8. Recurrence, progression and disease-specific death occurred in 69 (52.3%, mean 20.55 ± 20.44 months), 22 (16.7%, mean 31.39 ± 20.19 months) and 11 (8.3%, mean 37.23 ± 18.34 months), respectively. Smoke load significantly impacted recurrence, HR = 1.019 (95% CI 1.008-1.030, p = 0.0004), and progression, HR = 1.034 (95% CI 1.016-1.052, p = 0.0002), but not survival. For every 1-year increment in pack-years, the risk of relapse and progression increases by 1.9% and 3.4%, respectively. Over 20 pack-year showed the best predictive prognostic power.

CONCLUSION

The smoke load has a potential prognostic role in terms of recurrence and progression in the BCG treated NMIBC. Future studies should explore the smoking impact on the immune system, mainly beyond 20 pack-year.

Dose-Dependent Effect of Cotinine-Verified Tobacco Smoking on Serum Immunoglobulin E Levels in Korean Adult Males

BACKGROUND

Smoking is one of the risk factors to exacerbate allergic diseases, and it may affect serum immunoglobulin E (IgE) levels. However, few studies have relied on an objective biomarker to examine the effect of tobacco smoking on serum IgE levels.

METHOD

A nationwide cross-sectional study was conducted to examine the relationship between urinary cotinine (Ucot) concentrations and IgE levels in 973 males using data from the 2010 Korean National Health and Nutrition Examination Survey (KNHANES). Ucot was classified into four groups based on concentration (ng/mL) as follows: nonsmoker group (Ucot <50 ng/mL) and three tertile groups in smokers (T1 [Ucot: 50.00-921.28 ng/mL]; T2 [Ucot: 921.29-1869.36 ng/mL]; and T3 [Ucot ≥1869.37 ng/mL]). The dose-response relationships between Ucot concentrations and total serum IgE level were estimated using analysis of covariance (ANCOVA) and multiple linear regression analysis after adjusting for confounding variables.

RESULTS

We found a significant and positive dose-related effect of cigarette smoking as measured by Ucot concentrations on the total serum IgE level. The multivariate adjusted means of total serum IgE levels (SE) were 321.0 (36.3), 404.4 (102.7), 499.2 (79.2), and 534.7 (82.7) IU/mL, after adjusting for age, body mass index, alcohol ingestion, physical exercise, job, and household income. The regression coefficient β for total serum IgE was β = 68.6 with increasing level of Ucot group after adjusting for the same covariables (p = .009).

CONCLUSION

These findings suggest that the amount of smoking may have a dose-dependent effect on total serum IgE levels.

IMPLICATION

Smoking is one of the risk factors to exacerbate allergic diseases, and it may affect serum immunoglobulin E (IgE) levels, which is closely related to type 1 mediated allergic diseases. However, few studies have relied on an objective biomarker to examine the effect of tobacco smoking on serum IgE levels. We found that tobacco exposure, as measured by Ucot concentrations, increased the serum IgE levels in a dose-response manner in a representative sample of Korean adult males.

Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer

OBJECTIVES

To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC).

MATERIAL AND METHODS

A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10-55).

RESULTS

Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence.

CONCLUSIONS

In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer.