Does smoking status influence the prognosis of bladder cancer? A systematic review

Abstract

Objectives To summarize, in a systematic review, the evidence for the effect of stopping smoking on recurrence, cancer-specific and all cause-mortality among smokers with newly diagnosed bladder cancer. Materials and methods Two electronic databases and the reference lists of identified primary studies and reviews were searched. Studies were included if a hazard ratio and its confidence intervals could be extracted. A predefined set of study characteristics was extracted which defined whether studies were giving valid prognostic data on the effects of smoking in reasonably homogenous cohorts. The results of studies were synthesized qualitatively. Results Fifteen relevant studies were identified; former and current smokers were combined in many studies. Many studies produced information on prognosis that was confounded by the mixing of incident and prevalent cases. Only three studies examined the influence of smoking on prognosis in only incident cases, most of whom had superficial disease. Of these, only one was of high quality. These three studies and the other 12 showed suggestive evidence that continued smoking or a lifetime of smoking constitutes a moderate risk factor for recurrence and death, and that stopping smoking could favourably change this. However, the evidence base for this is weak because of the methodological shortcomings and because most studies' results were not statistically significant. A lifetable model showed that if stopping smoking altered the prognosis, the size of the benefit would be clinically worthwhile. Conclusions There is suggestive evidence that stopping smoking might favourably alter the course of bladder cancer, but this is insufficient for clinicians to inform patients that doing so will improve their prognosis, and for providing specialized services to assist in stopping smoking to patients with bladder cancer.

Clinical Significance of Smoking Cessation in Subjects With Cancer: A 30-Year Review

“…Although cigarette smoking is considered an established risk factor for the development of bladder cancer, 38 there has been no strong evidence on the effects of smoking on bladder cancer prognosis until recently. 39 The studies were well designed, with a large number of subjects and detailed recording of smoking status, including intensity and duration of smoking. Long-term heavy smokers with primary or recurrent urinary bladder cancer had the worst outcomes, a finding that emphasizes the necessity for smoking cessation counseling in urological patients.…”

Smoking Cessation after Bladder Cancer Diagnosis

“…Todavia, estudos demonstram que menos de metade dos doentes oncológicos fumadores ao diagnóstico se mantêm abstinentes. [32][33][34][35] Em trabalhos com CB, Vilensku et al 22 e Bassett et al 7 obtiveram 42% e 48% de abstinência após o diagnóstico. Neste estudo, e em linha com a alta prevalência, apenas 40,7% dos fumadores ao diagnóstico abandonaram o consumo, uma percentagem baixa que parece indicar que este teachable moment não está a ser adequadamente aproveitado, tanto pelos doentes na mudança de hábitos, como pelos médicos para uma atuação mais incisiva.…”

Differences in Tumor Characteristics and Prognosis in Newly Diagnosed Ta, T1 Urothelial Carcinoma of Bladder According to Patient Age

“…A recent systematic review concluded that cigarette smoking might be a weak factor influencing prognosis, but the results were inconclusive. 18 Some researchers have investigated the molecular and genetic differences among age groups; however, data are lacking with which to evaluate our hypothesis. Linn et al 19 studied genetic alterations in bladder cancer samples from patients Ͻ30 years and reported frequent p53 gene overexpression.…”