title: Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder.
abstract: BACKGROUND
  The aim of this study was to assess the influence of tobacco exposure, at the time of diagnosis, on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma (TCC) of the bladder.
  
  
  METHODS
  A retrospective cohort study was performed using the MSKCC Registry to identify all institutional cases of "noninvasive" TCC (n = 1632) between 1985 and 1995. After employing exclusion criteria, 286 cases of incident tobacco-associated superficial TCC were divided into 3 strata of tobacco exposure (127 ex-smokers, 51 quitters, and 108 continued smokers) by chart review and post hoc questionnaires (n = 82). Measured outcomes included recurrence free survival and survival free of adverse events (defined a priori as disease progression or other urinary tract TCC).
  
  
  RESULTS
  There were no significant differences among ex-smokers, quitters, and continued smokers in terms of stage, grade, tumor size, multifocality, up-front bacillus Calmette-Guérin therapy, or median follow-up. Ex-smokers presented at a later age than individuals who continued to smoke. Post hoc questionnaires and chart reviews were compared in terms of smoking status at time of diagnosis, and reliability was excellent (kappa = 0.89). Multivariate analyses revealed diminished recurrence free survival among continued smokers versus quitters or ex-smokers. Univariate analyses revealed diminished adverse event free survival among continued smokers versus quitters or ex-smokers. Multivariate models assessing adverse event free survival revealed a similar trend (P = 0.06).
  
  
  CONCLUSIONS
  Continued smokers experience worse disease-associated outcomes than patients who quit smoking. Smoking cessation should thus be employed as a tertiary prevention strategy for patients with superficial TCC.
authors.affiliation: Toronto Sunnybrook Regional Cancer Center, Toronto, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Fleshner
authors.forename: J
authors.initials: J
authors.lastname: Garland
authors.forename: A
authors.initials: A
authors.lastname: Moadel
authors.forename: H
authors.initials: H
authors.lastname: Herr
authors.forename: J
authors.initials: J
authors.lastname: Ostroff
authors.forename: R
authors.initials: R
authors.lastname: Trambert
authors.forename: M
authors.initials: M
authors.lastname: O'Sullivan
authors.forename: P
authors.initials: P
authors.lastname: Russo
mesh_terms: D000328:Adult; D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology* / Q000517:prevention & control; D017063:Outcome Assessment, Health Care; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D016019:Survival Analysis; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology*