***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of smoking on survival in cancer patients is limited by the lack of structured prospect i ve assessment s of smoking at diagnosis . To assess the effect of smoking at diagnosis on survival , structured smoking assessment s were obtained in a cohort of 5,185 cancer patients within 30 days of a cancer diagnosis between 1982 and 1998 .  Hazard ratios ( HRs ) or odds ratios were generated to analyze the effects of smoking at diagnosis on overall mortality ( OM ) and disease‐specific mortality ( DSM ) in a patient cohort from 13 disease sites containing at least 100 patients in each disease site . With a minimum of 12 years of follow‐up , current smoking increased OM risk versus recent quit ( HR 1.17 ) , former ( HR 1.29 ) and never smokers ( HR 1.38 ) in the overall cohort . Current smoking increased DSM risk versus former ( HR 1.23 ) and never smokers ( HR 1.18 ) . In disease sites with proportionately large ( > 20 % ) recent quit cohorts ( lung and head/neck ) , current smoking increased OM and DSM risks as compared with recent quit . Current smoking increased mortality risks in lung , head/neck , prostate and leukemia in men and breast , ovary , uterus and melanoma in women . Current smoking was not associated with any survival benefit in any disease site . Data using prospect i ve structured smoking assessment s demonstrate that current smoking increased long‐term OM and DSM . St and ardized smoking assessment at diagnosis is an important variable for evaluating outcomes in cancer patients Background : It is increasingly recognised that host-related factors may be important in determining cancer outcome . The aim was to examine the relationship between patient physiology , the systemic inflammatory response and survival after colorectal cancer resection . Methods : Patients undergoing potentially curative resection of colorectal cancer were identified from a prospect ively maintained data base . Patient physiology was assessed using the  physiological and operative severity score for the enumeration of mortality and morbidity ( POSSUM ) criteria . The systemic inflammatory response was assessed using the modified Glasgow Prognostic Score ( mGPS ) . Multivariate 5-year survival analysis was carried out with calculation of hazard ratios ( HR ) . Results : A total of 320 patients were included . During follow-up ( median 74 months ) , there were 136 deaths : 83 colorectal cancer related and 53 non-cancer related . Independent predictors of cancer-specific survival were age ( HR : 1.46 , P<0.01 ) , Dukes stage ( HR : 2.39 , P<0.001 ) , mGPS ( HR : 1.78 , P<0.001 ) and POSSUM physiology score ( HR : 1.38 , P=0.02 ) . Predictors of overall survival were age ( HR : 1.64 , P<0.001 ) , smoking ( HR : 1.52 , P=0.02 ) , Dukes stage ( HR : 1.64 , P<0.001 ) , mGPS ( HR : 1.60 , P<0.001 ) and POSSUM physiology score ( HR : 1.27 , P=0.03 ) . A relationship between mGPS and POSSUM physiology score was also established ( P<0.006 ) . Conclusion : The POSSUM physiology score and the systemic inflammatory response are strongly associated and both are independent predictors of cancer specific and overall survival in patients undergoing potentially curative resection of colorectal cancer BACKGROUND Cigarette smoking is an established risk factor for colorectal cancer . Because colorectal carcinogenesis is a heterogeneous process , we investigated whether cigarette smoking is differentially associated with molecularly defined subtypes of colorectal cancer . METHODS We evaluated associations between smoking and incident colorectal cancer  , overall and by microsatellite instability ( MSI ) phenotype ( MSI-high vs MSI-low or microsatellite stable ) , CpG isl and methylator phenotype ( CIMP positive or CIMP negative ) , and BRAF mutation status ( BRAF mutation positive or BRAF mutation negative ) , among 37 399 participants in a population -based cohort study ( the Iowa Women 's Health Study ) .  Cigarette smoking ( and other exposures ) was assessed by self-report at baseline in 1986 , including smoking status ( never and ever [ former or current ] ) , age at initiation , total duration , average number of cigarettes smoked per day , cumulative pack-years , and induction period . Vital status and state of residence were determined by mailed follow-up question naires in 1987 , 1989 , 1992 , and 1997 and by linkage to Iowa death certificate records . Nonrespondents were checked via the National Death Index to identify descendants . Participants with newly diagnosed ( ie , incident ) colorectal cancer were identified through annual linkage with the Iowa Cancer Registry . Archived paraffin-embedded tumor tissue specimens were obtained for 555 patients with colorectal cancer who were diagnosed from January 1 , 1986 , through December 31 , 2002 , and MSI status , CIMP status , and BRAF status were determined . Multivariable Cox regression models were fit to estimate relative risks ( RRs ) and 95 % confidence intervals ( CIs ) . RESULTS Ever-smokers were at moderately increased risk for incident colorectal cancer ( RR = 1.19 , 95 % CI = 1.05 to 1.35 ) compared with never-smokers . Higher risk estimates were observed for current smokers with MSI-high tumors ( RR = 1.99 , 95 % CI = 1.26 to 3.14 ) , CIMP-positive tumors ( RR = 1.88 , 95 % CI = 1.22 to 2.90 ) , and BRAF mutation-positive tumors ( RR = 1.92 , 95 % CI = 1.22 to 3.02 ) . Other smoking-related variables ( ie , age at initiation , total duration , average number of cigarettes smoked per day , cumulative pack-years , and induction period ) were also associated with MSI-high , CIMP-positive , and BRAF mutation-positive tumor subtypes . Conversely , cigarette smoking status ( ever vs never ) was not associated with the MSI-low or microsatellite stable ( RR = 1.00 , 95 % CI = 0.79 to 1.25 ) , CIMP-negative ( RR = 1.02 , 95 % CI = 0.81 to 1.30 ) , or BRAF mutation-negative subtypes ( RR = 1.00 , 95 % CI = 0.65 to 1.27 ) . CONCLUSIONS In this prospect i ve study of older women , cigarette smoking was associated with the MSI-high , CIMP-positive , and BRAF mutation-positive colorectal cancer subtypes , which indicates that epigenetic modification may be functionally involved in smoking-related colorectal carcinogenesis PURPOSE By using data from North Central Cancer Treatment Group Phase III Trial N0147 , a r and omized adjuvant trial of patients with stage III colon cancer , we assessed the relationship between smoking and cancer outcomes , disease-free survival ( DFS ) , and time to recurrence ( TTR ) , accounting for heterogeneity by patient and tumor characteristics . PATIENTS AND METHODS Before r and om assignment to infusional fluorouracil , leucovorin , and oxaliplatin ( FOLFOX ) or FOLFOX plus cetuximab , 1,968 participants completed a question naire on smoking history and other risk factors . Cox models assessed the association between smoking history and the primary trial outcome of DFS ( ie , time to recurrence or death ) , as well as TTR , adjusting for other clinical and patient factors . The median follow-up was 3.5 years among patients who did not experience events . RESULTS Compared with never-smokers , ever smokers experienced significantly shorter DFS ( 3-year DFS proportion : 70 % v 74 % ; hazard ratio [ HR ] , 1.21 ; 95 % CI , 1.02 to 1.42 ) . This association persisted after multivariate adjustment ( HR , 1.23 ; 95 % CI , 1.02 to 1.49 ) . There was significant interaction in this association by BRAF mutation status ( P = .03 ) : smoking was associated with shorter DFS in patients with BRAF wild-type ( HR , 1.36 ; 95 % CI , 1.11 to 1.66 ) but not BRAF mutated ( HR , 0.80 ; 95 % CI , 0.50 to 1.29 ) colon cancer . Smoking was more strongly associated with poorer DFS in those with KRAS mutated versus KRAS wild-type colon cancer ( HR , 1.50 [ 95 % CI , 1.12 to 2.00 ] v HR , 1.09 [ 95 % CI , 0.85 to 1.39 ] ) , although interaction by KRAS mutation status was not statistically significant ( P = .07 ) . Associations were comparable in analyses of TTR . CONCLUSION Overall , smoking was significantly associated with shorter DFS and TTR in patients with colon cancer . These adverse relationships were most evident in patients with BRAF wild-type or KRAS mutated colon cancer 
    Output:
    
Our results support the existence of detrimental effects of smoking on survival also after CRC diagnosis .