Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer

Michael Rink, Helena Furberg, Emily C. Zabor, Evanguelos Xylinas, Marko Babjuk, Armin Pycha, Yair Lotan, Pierre I. Karakiewicz, Giacomo Novara, Brian D. Robinson, Francesco Montorsi, Felix K. Chun, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

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Abstract

Background: Cigarette smoking is the best-established risk factor for urothelial carcinoma (UC) development, but the impact on oncologic outcomes remains poorly understood. Objective: To analyse the effects of smoking status, cumulative exposure, and time from smoking cessation on the prognosis of patients with primary non-muscle-invasive bladder cancer (NMIBC). Design, setting, and participants: We collected smoking data from 2043 patients with primary NMIBC. Smoking variables included smoking status, average number of cigarettes smoked per day (CPD), duration in years, and time since smoking cessation. Lifetime cumulative smoking exposure was categorised as light short term (≤19 CPD, ≤19.9 yr), light long term (≤19 CPD, ≥20 yr), heavy short term (≥20 CPD, ≤19.9 yr) and heavy long term (≥20 CPD, ≥20 yr). The median follow-up in this retrospective study was 49 mo. Interventions: Transurethral resection of the bladder with or without intravesical instillation therapy. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on outcomes. Results and limitations: There was no difference in clinicopathologic factors among never (24%), former (47%), and current smokers (29%). Smoking status was associated with the cumulative incidence of disease progression in multivariable analysis (p = 0.003); current smokers had the highest cumulative incidences. Among current and former smokers, cumulative smoking exposure was associated with disease recurrence (p < 0.001), progression (p < 0.001), and overall survival (p < 0.001) in multivariable analyses that adjusted for the effects of standard clinicopathologic factors and smoking status; 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 reduced the risk of disease recurrence (hazard ratio [HR]: 0.66; 95% confidence interval [CI], 0.52-0.84; p < 0.001) and progression (HR: 0.42; 95% CI, 0.22-0.83; p = 0.036) in multivariable analyses. The study is limited by its retrospective nature. Conclusions: Smoking status and a higher cumulative smoking exposure are associated with worse prognosis in patients with NMIBC. Smoking cessation >10 yr abrogates this detrimental effect. These findings underscore the need for integrated smoking cessation and prevention programmes in the management of NMIBC patients.

Original languageEnglish (US)
Pages (from-to)724-732
Number of pages9
JournalEuropean Urology
Volume63
Issue number4
DOIs
StatePublished - Apr 2013

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Smoking Cessation
Urinary Bladder Neoplasms
Smoking
Tobacco Products
Intravesical Administration
Light
Recurrence
Incidence
Disease Progression
Urinary Bladder
Retrospective Studies
Logistic Models
Regression Analysis
Confidence Intervals
Carcinoma

Keywords

  • Dose-response relationship
  • Non-muscle-invasive bladder cancer
  • Progression
  • Recurrence
  • Smoking
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Rink, M., Furberg, H., Zabor, E. C., Xylinas, E., Babjuk, M., Pycha, A., ... Shariat, S. F. (2013). Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. European Urology, 63(4), 724-732. https://doi.org/10.1016/j.eururo.2012.08.025

Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. / Rink, Michael; Furberg, Helena; Zabor, Emily C.; Xylinas, Evanguelos; Babjuk, Marko; Pycha, Armin; Lotan, Yair; Karakiewicz, Pierre I.; Novara, Giacomo; Robinson, Brian D.; Montorsi, Francesco; Chun, Felix K.; Scherr, Douglas S.; Shariat, Shahrokh F.

In: European Urology, Vol. 63, No. 4, 04.2013, p. 724-732.

Research output: Contribution to journalArticle

Rink, M, Furberg, H, Zabor, EC, Xylinas, E, Babjuk, M, Pycha, A, Lotan, Y, Karakiewicz, PI, Novara, G, Robinson, BD, Montorsi, F, Chun, FK, Scherr, DS & Shariat, SF 2013, 'Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer', European Urology, vol. 63, no. 4, pp. 724-732. https://doi.org/10.1016/j.eururo.2012.08.025
Rink, Michael ; Furberg, Helena ; Zabor, Emily C. ; Xylinas, Evanguelos ; Babjuk, Marko ; Pycha, Armin ; Lotan, Yair ; Karakiewicz, Pierre I. ; Novara, Giacomo ; Robinson, Brian D. ; Montorsi, Francesco ; Chun, Felix K. ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. In: European Urology. 2013 ; Vol. 63, No. 4. pp. 724-732.
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abstract = "Background: Cigarette smoking is the best-established risk factor for urothelial carcinoma (UC) development, but the impact on oncologic outcomes remains poorly understood. Objective: To analyse the effects of smoking status, cumulative exposure, and time from smoking cessation on the prognosis of patients with primary non-muscle-invasive bladder cancer (NMIBC). Design, setting, and participants: We collected smoking data from 2043 patients with primary NMIBC. Smoking variables included smoking status, average number of cigarettes smoked per day (CPD), duration in years, and time since smoking cessation. Lifetime cumulative smoking exposure was categorised as light short term (≤19 CPD, ≤19.9 yr), light long term (≤19 CPD, ≥20 yr), heavy short term (≥20 CPD, ≤19.9 yr) and heavy long term (≥20 CPD, ≥20 yr). The median follow-up in this retrospective study was 49 mo. Interventions: Transurethral resection of the bladder with or without intravesical instillation therapy. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on outcomes. Results and limitations: There was no difference in clinicopathologic factors among never (24{\%}), former (47{\%}), and current smokers (29{\%}). Smoking status was associated with the cumulative incidence of disease progression in multivariable analysis (p = 0.003); current smokers had the highest cumulative incidences. Among current and former smokers, cumulative smoking exposure was associated with disease recurrence (p < 0.001), progression (p < 0.001), and overall survival (p < 0.001) in multivariable analyses that adjusted for the effects of standard clinicopathologic factors and smoking status; 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 reduced the risk of disease recurrence (hazard ratio [HR]: 0.66; 95{\%} confidence interval [CI], 0.52-0.84; p < 0.001) and progression (HR: 0.42; 95{\%} CI, 0.22-0.83; p = 0.036) in multivariable analyses. The study is limited by its retrospective nature. Conclusions: Smoking status and a higher cumulative smoking exposure are associated with worse prognosis in patients with NMIBC. Smoking cessation >10 yr abrogates this detrimental effect. These findings underscore the need for integrated smoking cessation and prevention programmes in the management of NMIBC patients.",
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T1 - Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer

AU - Rink, Michael

AU - Furberg, Helena

AU - Zabor, Emily C.

AU - Xylinas, Evanguelos

AU - Babjuk, Marko

AU - Pycha, Armin

AU - Lotan, Yair

AU - Karakiewicz, Pierre I.

AU - Novara, Giacomo

AU - Robinson, Brian D.

AU - Montorsi, Francesco

AU - Chun, Felix K.

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2013/4

Y1 - 2013/4

N2 - Background: Cigarette smoking is the best-established risk factor for urothelial carcinoma (UC) development, but the impact on oncologic outcomes remains poorly understood. Objective: To analyse the effects of smoking status, cumulative exposure, and time from smoking cessation on the prognosis of patients with primary non-muscle-invasive bladder cancer (NMIBC). Design, setting, and participants: We collected smoking data from 2043 patients with primary NMIBC. Smoking variables included smoking status, average number of cigarettes smoked per day (CPD), duration in years, and time since smoking cessation. Lifetime cumulative smoking exposure was categorised as light short term (≤19 CPD, ≤19.9 yr), light long term (≤19 CPD, ≥20 yr), heavy short term (≥20 CPD, ≤19.9 yr) and heavy long term (≥20 CPD, ≥20 yr). The median follow-up in this retrospective study was 49 mo. Interventions: Transurethral resection of the bladder with or without intravesical instillation therapy. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on outcomes. Results and limitations: There was no difference in clinicopathologic factors among never (24%), former (47%), and current smokers (29%). Smoking status was associated with the cumulative incidence of disease progression in multivariable analysis (p = 0.003); current smokers had the highest cumulative incidences. Among current and former smokers, cumulative smoking exposure was associated with disease recurrence (p < 0.001), progression (p < 0.001), and overall survival (p < 0.001) in multivariable analyses that adjusted for the effects of standard clinicopathologic factors and smoking status; 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 reduced the risk of disease recurrence (hazard ratio [HR]: 0.66; 95% confidence interval [CI], 0.52-0.84; p < 0.001) and progression (HR: 0.42; 95% CI, 0.22-0.83; p = 0.036) in multivariable analyses. The study is limited by its retrospective nature. Conclusions: Smoking status and a higher cumulative smoking exposure are associated with worse prognosis in patients with NMIBC. Smoking cessation >10 yr abrogates this detrimental effect. These findings underscore the need for integrated smoking cessation and prevention programmes in the management of NMIBC patients.

AB - Background: Cigarette smoking is the best-established risk factor for urothelial carcinoma (UC) development, but the impact on oncologic outcomes remains poorly understood. Objective: To analyse the effects of smoking status, cumulative exposure, and time from smoking cessation on the prognosis of patients with primary non-muscle-invasive bladder cancer (NMIBC). Design, setting, and participants: We collected smoking data from 2043 patients with primary NMIBC. Smoking variables included smoking status, average number of cigarettes smoked per day (CPD), duration in years, and time since smoking cessation. Lifetime cumulative smoking exposure was categorised as light short term (≤19 CPD, ≤19.9 yr), light long term (≤19 CPD, ≥20 yr), heavy short term (≥20 CPD, ≤19.9 yr) and heavy long term (≥20 CPD, ≥20 yr). The median follow-up in this retrospective study was 49 mo. Interventions: Transurethral resection of the bladder with or without intravesical instillation therapy. Outcome measurements and statistical analysis: Univariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on outcomes. Results and limitations: There was no difference in clinicopathologic factors among never (24%), former (47%), and current smokers (29%). Smoking status was associated with the cumulative incidence of disease progression in multivariable analysis (p = 0.003); current smokers had the highest cumulative incidences. Among current and former smokers, cumulative smoking exposure was associated with disease recurrence (p < 0.001), progression (p < 0.001), and overall survival (p < 0.001) in multivariable analyses that adjusted for the effects of standard clinicopathologic factors and smoking status; 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 reduced the risk of disease recurrence (hazard ratio [HR]: 0.66; 95% confidence interval [CI], 0.52-0.84; p < 0.001) and progression (HR: 0.42; 95% CI, 0.22-0.83; p = 0.036) in multivariable analyses. The study is limited by its retrospective nature. Conclusions: Smoking status and a higher cumulative smoking exposure are associated with worse prognosis in patients with NMIBC. Smoking cessation >10 yr abrogates this detrimental effect. These findings underscore the need for integrated smoking cessation and prevention programmes in the management of NMIBC patients.

KW - Dose-response relationship

KW - Non-muscle-invasive bladder cancer

KW - Progression

KW - Recurrence

KW - Smoking

KW - Survival

KW - Urothelial carcinoma

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