Impact of smoking on outcomes of patients with a history of recurrent nonmuscle invasive bladder cancer.
OBJECTIVE
We investigated the effects of cigarette smoking status, cumulative exposure and time from cessation on disease recurrence and progression in patients with a history of recurrent nonmuscle invasive bladder cancer.


METHODS
A total of 390 patients with recurrent nonmuscle invasive bladder cancer were treated with transurethral resection of the bladder, of whom 159 (41%) received instillation therapy immediately postoperatively and 73 (19%) received adjuvant intravesical immunotherapy or chemotherapy. Smoking history included smoking status, number of cigarettes per day, smoking duration in years and years since smoking cessation. Cumulative smoking exposure was categorized as light short-term--19 or fewer cigarettes per day and 19.9 years or less, moderate--all combinations except light short-term and heavy long-term, and heavy long-term--20 or greater cigarettes per day and 20 years or greater.


RESULTS
A total of 91 (23%), 192 (49%) and 107 patients (28%) were never, former and current smokers, respectively. Of ever smokers 56 (19%), 156 (52%) and 87 (29%) were light short-term, moderate and heavy long-term smokers, respectively. There was no difference in the risk of disease recurrence and progression among current, former and never smokers. On univariable analyses in ever smokers the risk of disease recurrence and progression increased with augmented smoking intensity (p ≤ 0.015), duration (p <0.001) and cumulative exposure (p <0.001). On multivariable analyses cumulative smoking exposure was an independent risk factor for disease recurrence and progression (p ≤ 0.003). Smoking cessation greater than 10 years before treatment was independently associated with decreased disease recurrence compared to current smoking (HR 0.4, p <0.001). In addition, current smokers had worse survival than former smokers, who in turn had worse survival than never smokers (p >0.05).


CONCLUSIONS
There is a dose-response relationship of smoking exposure and smoking cessation with disease recurrence and progression in ever smokers with a history of recurrent nonmuscle invasive bladder cancer. These findings support counseling on smoking cessation benefits.
Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York 10065, USA.
Michael
M
Rink
Evanguelos
E
Xylinas
Marko
M
Babjuk
Jens
J
Hansen
Armin
A
Pycha
Evi
E
Comploj
Yair
Y
Lotan
Maxine
M
Sun
Pierre I
PI
Karakiewicz
Joual
J
Abdennabi
Harun
H
Fajkovic
Wolfgang
W
Loidl
Felix K
FK
Chun
Margit
M
Fisch
Douglas S
DS
Scherr
Shahrokh F
SF
Shariat
D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy