TY - JOUR
T1 - Impact of smoking on outcomes of patients with a history of recurrent nonmuscle invasive bladder cancer
AU - Rink, Michael
AU - Xylinas, Evanguelos
AU - Babjuk, Marko
AU - Hansen, Jens
AU - Pycha, Armin
AU - Comploj, Evi
AU - Lotan, Yair
AU - Sun, Maxine
AU - Karakiewicz, Pierre I.
AU - Abdennabi, Joual
AU - Fajkovic, Harun
AU - Loidl, Wolfgang
AU - Chun, Felix K.
AU - Fisch, Margit
AU - Scherr, Douglas S.
AU - Shariat, Shahrokh F.
N1 - Funding Information:
Supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust (MR).
PY - 2012/12
Y1 - 2012/12
N2 - Purpose: 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. Materials and 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.
AB - Purpose: 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. Materials and 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.
KW - carcinoma
KW - smoking
KW - survival
KW - urinary bladder
KW - urothelium
UR - http://www.scopus.com/inward/record.url?scp=84869089629&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84869089629&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2012.08.029
DO - 10.1016/j.juro.2012.08.029
M3 - Article
C2 - 23083868
AN - SCOPUS:84869089629
SN - 0022-5347
VL - 188
SP - 2120
EP - 2128
JO - Journal of Urology
JF - Journal of Urology
IS - 6
ER -