The Impact of Cigarette Smoking on Stage, Grade and Number of Recurrences of Transitional Cell Carcinoma of the Bladder

Thompson, Ian M.; Peek, Michael; Rodriguez, Francisco R.

doi:10.1016/s0022-5347(17)44048-1

Cited by 62 publications

(24 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is in accordance with studies that reported an association between smoking quantity and duration and the risk of UCB development and aggressiveness [6,11,23]. Indeed, increasing the number of CPD and years of smoking has been shown to be associated with more advanced and higher-grade tumours [11,12,23]. Interestingly, the HRs indicate a stronger effect of smoking duration than quantity on clinical outcomes.…”

Section: Discussionsupporting

confidence: 90%

“…Although smoking has steadily declined over the past decades, 40% of US adults are current or former smokers [7,8]. Although smoking status has been associated with more advanced tumour stage and grade as well as disease recurrence and progression in NMIBC, conclusions are limited by small sample sizes and analytical approaches of published studies [9–12]. Indeed, the relationships among smoking status, intensity, and time from smoking cessation with biologic behaviour of NMIBC remain insufficiently understood.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Smoking and Smoking Cessation on Oncologic Outcomes in Primary Non–muscle-invasive Bladder Cancer

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Impact of Smoking and Smoking Cessation on Oncologic Outcomes in Primary Non–muscle-invasive Bladder Cancer

et al. 2013

View full text Add to dashboard Cite

show abstract

“…At the time of RNU, up to 50% of patients have non–organ-confined disease or lymph node metastasis; 50–70% of these patients eventually die of UTUC within 5 yr of their RNU [6–8]. Cumulative evidence suggests an association between smoking and more advanced disease stage and grade as well as disease recurrence in urothelial carcinoma of the bladder (UCB) [9–13]. However, to the best of our knowledge, no study has yet assessed the impact of different aspects of smoking behavior on UTUC outcomes in patients treated with RNU.…”

Section: Introductionmentioning

confidence: 99%

Impact of Smoking on Oncologic Outcomes of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

et al. 2013

View full text Add to dashboard Cite

Background Ci garette smoking is a common risk factor for developing upper tract urothelial carcinoma (UTUC). Objective To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on oncologic UTUC outcomes in patients treated with radical nephroureterectomy (RNU). Design, setting, and participants A total of 864 patients underwent RNU at five institutions. The median follow-up in this retrospective study was 50 mo. Smoking history included smoking status, quantity of cigarettes per day (CPD), duration in years, and years from smoking cessation. The cumulative smoking exposure was categorized as light-short-term (≤19 CPD and ≤19.9 yr), moderate (all combinations except light-short-term and heavy-long-term), and heavy-long-term (≥ 20CPD and ≥ 20 yr). Interventions RNU with or without lymph node dissection. No patient received neoadjuvant chemotherapy. Outcome measurements and statistical analysis Univariable and multivariable logistic regression and competing risk regression analyses assessed the effects of smoking on oncologic outcomes. Results and limitations A total of 244 patients (28.2%) never smoked; 297 (34.4%) and 323 (37.4%) were former and current smokers, respectively. Among smokers, 87 (10.1%), 331 (38.3%), and 202 (23.4%) were light-short-term, moderate, and heavy-long-term smokers, respectively. Current smoking status, smoking ≥20CPD ≥20 yr, and heavy-long-term smoking were associated with advanced disease (p values ≤0.004), greater likelihood of disease recurrence (p values ≤0.01), and cancer-specific mortality (p values ≤0.05) on multivariable analyses that adjusted for standard features. Patients who quit smoking ≥10 yr prior to RNU did not differ from never smokers regarding advanced tumor stages, disease recurrence, and cancer-specific mortality, but they had better oncologic outcomes then current smokers and those patients who quit smoking <10 yr prior to RNU. The study is limited by its retrospective nature. Conclusions Cigarette smoking is significantly associated with advanced disease stages, disease recurrence, and cancer-specific mortality in patients treated with RNU for UTUC. Current smokers and those with a heavy and long-term smoking exposure have the highest risk for poor oncologic outcomes. Smoking cessation >10 yr prior to RNU seems to mitigate some detrimental effects. These results underscore the need for smoking cessation and prevention programs.

show abstract

“…Tumor invasion is promoted by factors that alter the tumor microenvironment such as overexpression of cyclooxygenase 2 (COX-2). It has been suggested that etiologic factors, such as cigarette smoking, may be differentially associated with bladder cancer severity 8-13 . Here we examine associations between cigarette smoking and bladder cancer risk taking into account tumor subtypes.…”

Section: Introductionmentioning

confidence: 99%

Cigarette smoking and subtypes of bladder cancer

Jiang¹,

Castelao²,

Yuan³

et al. 2011

Intl Journal of Cancer

View full text Add to dashboard Cite

There is little information regarding associations between suspected bladder cancer risk factors and tumor subtypes at diagnosis. Some, but not all, studies have found that bladder cancer among smokers is often more invasive than it is among nonsmokers. This population-based case-control study was conducted in Los Angeles, California, involving 1,586 bladder cancer patients and their individually matched controls. Logistic regression was used to conduct separate analyses according to tumor subtypes defined by stage and grade. Cigarette smoking increased risk of both superficial and invasive bladder cancer, but the more advanced the stage, the stronger the effect. The odds ratios associated with regular smokers were 2.2 (95% confidence intervals, 1.8-2.8), 2.7 (2.1-3.6) and 3.7 (2.5-5.5) for low-grade superficial, high-grade superficial and invasive tumors respectively. This pattern was consistently observed regardless of the smoking exposure index under examination. Women had higher risk of invasive bladder cancer than men even they smoked comparable amount of cigarettes as men. There was no gender difference in the association between smoking and risk of low-grade superficial bladder cancer. The heterogeneous effect of cigarette smoking was attenuated among heavy users of NSAIDs. Our results indicate that cigarette smoking was more strongly associated with increased risk of invasive bladder cancer than with low-grade superficial bladder cancer.

show abstract

The Impact of Cigarette Smoking on Stage, Grade and Number of Recurrences of Transitional Cell Carcinoma of the Bladder

Cited by 62 publications

References 8 publications

Impact of Smoking and Smoking Cessation on Oncologic Outcomes in Primary Non–muscle-invasive Bladder Cancer

Impact of Smoking and Smoking Cessation on Oncologic Outcomes in Primary Non–muscle-invasive Bladder Cancer

Impact of Smoking on Oncologic Outcomes of Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy

Cigarette smoking and subtypes of bladder cancer

Contact Info

Product

Resources

About