title: Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy.
abstract: BACKGROUND
  Cigarette smoking is the best-established risk factor for urothelial carcinoma development.
  
  
  OBJECTIVE
  To elucidate the association of pretreatment smoking status, cumulative exposure, and time since smoking cessation on outcomes of patients with urothelial carcinoma of the bladder (UCB) treated with radical cystectomy (RC).
  
  
  METHODS
  We retrospectively collected clinicopathologic and smoking variables, including smoking status, number of cigarettes per day (CPD), duration in years, and time since smoking cessation, for 1506 patients treated with RC for UCB. Lifetime cumulative smoking exposure was categorized as light short-term (≤20 CPD for ≤20 yr), light long-term (≤20 CPD for >20 yr), heavy short-term (>20 CPD for ≤20 yr), and heavy long-term (>20 CPD for >20 yr).
  
  
  METHODS
  RC and bilateral lymph node (LN) dissection without neoadjuvant chemotherapy.
  
  
  METHODS
  Logistic regression and competing risk analyses assessed the association of smoking with disease recurrence, cancer-specific mortality, and overall mortality.
  
  
  CONCLUSIONS
  There was no difference in clinicopathologic factors between patients who had never smoked (20%), former smokers (46%), and current smokers (34%). Smoking status was associated with the cumulative incidence of disease recurrence (p=0.004) and cancer-specific mortality (p=0.016) in univariable analyses and with disease recurrence in multivariable analysis (p=0.02); current smokers had the highest cumulative incidences. Among ever smokers, cumulative smoking exposure was associated with advanced tumor stages (p<0.001), LN metastasis (p=0.002), disease recurrence (p<0.001), cancer-specific mortality (p=0.001), and overall mortality (p=0.037) in multivariable analyses that adjusted for standard characteristics; heavy long-term smokers had the worst outcomes, followed by light long-term, heavy short-term, and light short-term smokers. Smoking cessation ≥10 yr mitigated the risk of disease recurrence (hazard ratio [HR]: 0.44; p<0.001), cancer-specific mortality (HR: 0.42; p<0.001), and overall mortality (HR: 0.69; p=0.012) in multivariable analyses. The study is limited by its retrospective nature.
  
  
  CONCLUSIONS
  Smoking is associated with worse prognosis after RC for UCB. This association seems to be dose-dependent, and its effects are mitigated by >10 yr smoking cessation. Health care practitioners should counsel smokers regarding the detrimental effects of smoking and the benefits of smoking cessation on UCB etiology and prognosis.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10065, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.forename: Emily C
authors.initials: EC
authors.lastname: Zabor
authors.forename: Helena
authors.initials: H
authors.lastname: Furberg
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: Behfar
authors.initials: B
authors.lastname: Ehdaie
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Marko
authors.initials: M
authors.lastname: Babjuk
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Brian D
authors.initials: BD
authors.lastname: Robinson
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009656:North America; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*