Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy

Michael Rink, Emily C. Zabor, Helena Furberg, Evanguelos Xylinas, Behfar Ehdaie, Giacomo Novara, Marko Babjuk, Armin Pycha, Yair Lotan, Quoc Dien Trinh, Felix K. Chun, Richard K. Lee, Pierre I. Karakiewicz, Margit Fisch, Brian D. Robinson, Douglas S. Scherr, Shahrokh F. Shariat

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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). Design, setting, and participants: 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). Intervention: RC and bilateral lymph node (LN) dissection without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Logistic regression and competing risk analyses assessed the association of smoking with disease recurrence, cancer-specific mortality, and overall mortality. Results and limitations: 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.

Original languageEnglish (US)
Pages (from-to)456-464
Number of pages9
JournalEuropean Urology
Volume64
Issue number3
DOIs
StatePublished - Sep 2013

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Cystectomy
Smoking Cessation
Urinary Bladder Neoplasms
Smoking
Tobacco Products
Carcinoma
Urinary Bladder
Recurrence
Mortality
Light
Neoplasms
Incidence
Lymph Node Excision
Logistic Models
Delivery of Health Care
Drug Therapy

Keywords

  • Dose response
  • Muscle-invasive bladder cancer
  • Progression
  • Radical cystectomy
  • Recurrence
  • Smoking
  • Survival
  • Urothelial carcinoma

ASJC Scopus subject areas

  • Urology

Cite this

Rink, M., Zabor, E. C., Furberg, H., Xylinas, E., Ehdaie, B., Novara, G., ... Shariat, S. F. (2013). Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy. European Urology, 64(3), 456-464. https://doi.org/10.1016/j.eururo.2012.11.039

Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy. / Rink, Michael; Zabor, Emily C.; Furberg, Helena; Xylinas, Evanguelos; Ehdaie, Behfar; Novara, Giacomo; Babjuk, Marko; Pycha, Armin; Lotan, Yair; Trinh, Quoc Dien; Chun, Felix K.; Lee, Richard K.; Karakiewicz, Pierre I.; Fisch, Margit; Robinson, Brian D.; Scherr, Douglas S.; Shariat, Shahrokh F.

In: European Urology, Vol. 64, No. 3, 09.2013, p. 456-464.

Research output: Contribution to journalArticle

Rink, M, Zabor, EC, Furberg, H, Xylinas, E, Ehdaie, B, Novara, G, Babjuk, M, Pycha, A, Lotan, Y, Trinh, QD, Chun, FK, Lee, RK, Karakiewicz, PI, Fisch, M, Robinson, BD, Scherr, DS & Shariat, SF 2013, 'Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy', European Urology, vol. 64, no. 3, pp. 456-464. https://doi.org/10.1016/j.eururo.2012.11.039
Rink, Michael ; Zabor, Emily C. ; Furberg, Helena ; Xylinas, Evanguelos ; Ehdaie, Behfar ; Novara, Giacomo ; Babjuk, Marko ; Pycha, Armin ; Lotan, Yair ; Trinh, Quoc Dien ; Chun, Felix K. ; Lee, Richard K. ; Karakiewicz, Pierre I. ; Fisch, Margit ; Robinson, Brian D. ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy. In: European Urology. 2013 ; Vol. 64, No. 3. pp. 456-464.
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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). Design, setting, and participants: 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). Intervention: RC and bilateral lymph node (LN) dissection without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Logistic regression and competing risk analyses assessed the association of smoking with disease recurrence, cancer-specific mortality, and overall mortality. Results and limitations: 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.",
keywords = "Dose response, Muscle-invasive bladder cancer, Progression, Radical cystectomy, Recurrence, Smoking, Survival, Urothelial carcinoma",
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TY - JOUR

T1 - Impact of smoking and smoking cessation on outcomes in bladder cancer patients treated with radical cystectomy

AU - Rink, Michael

AU - Zabor, Emily C.

AU - Furberg, Helena

AU - Xylinas, Evanguelos

AU - Ehdaie, Behfar

AU - Novara, Giacomo

AU - Babjuk, Marko

AU - Pycha, Armin

AU - Lotan, Yair

AU - Trinh, Quoc Dien

AU - Chun, Felix K.

AU - Lee, Richard K.

AU - Karakiewicz, Pierre I.

AU - Fisch, Margit

AU - Robinson, Brian D.

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2013/9

Y1 - 2013/9

N2 - 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). Design, setting, and participants: 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). Intervention: RC and bilateral lymph node (LN) dissection without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Logistic regression and competing risk analyses assessed the association of smoking with disease recurrence, cancer-specific mortality, and overall mortality. Results and limitations: 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.

AB - 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). Design, setting, and participants: 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). Intervention: RC and bilateral lymph node (LN) dissection without neoadjuvant chemotherapy. Outcome measurements and statistical analysis: Logistic regression and competing risk analyses assessed the association of smoking with disease recurrence, cancer-specific mortality, and overall mortality. Results and limitations: 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.

KW - Dose response

KW - Muscle-invasive bladder cancer

KW - Progression

KW - Radical cystectomy

KW - Recurrence

KW - Smoking

KW - Survival

KW - Urothelial carcinoma

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