Abstract
Purpose
We investigated whether smoking cessation could have preventative effects against tumor recurrence in patients with non-muscle invasive bladder cancer (NMIBC).
Methods
Our study population comprised 634 patients with initially diagnosed NMIBC at Keio University Hospital, Saiseikai Central Hospital, and Saitama Medical University Hospital between 1995 and 2012. We analyzed the relationships between tumor recurrence in NMIBC and patient clinicopathological parameters, including smoking status.
Results
Overall, 181 patients (28.5 %) were classified as current smokers, 154 (24.3 %) as former smokers, and 299 (47.2 %) as non-smokers. Kaplan–Meier curve analysis revealed that the tumor recurrence rate was significantly lower in the non-smoker group than in the current- and former-smoker groups (p < 0.001 and p < 0.001, respectively). In the 154 former smokers, Kaplan–Meier curve analysis revealed that smoking intensity and duration was not associated with tumor recurrence rate; however, patients with a smoking cessation period of 15 years or more had a significantly lower tumor recurrence rate than their counterparts (p < 0.001). A multivariate analysis identified a smoking cessation period of <15 years (hazard ratio [HR] 2.20; p = 0.003) and T1 tumors (HR 1.99; p = 0.013) as independent risk factors for tumor recurrence in the former-smokers subgroup.
Conclusions
A positive smoking history was identified as one of the independent risk factors for bladder tumor recurrence after transurethral resection of the bladder tumor. Furthermore, refraining from smoking for 15 years or more reduced the risk of tumor recurrence in former smokers with NMIBC regardless of the intensity or duration of smoking. Therefore, smoking cessation may reduce the risk of tumor recurrence in patients with NMIBC.
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References
van Rhijn BW, Burger M, Lotan Y, et al. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy. Eur Urol. 2009;56(3):430–42.
Freedman ND, Silverman DT, Hollenbeck AR, Schatzkin A, Abnet CC. Association between smoking and risk of bladder cancer among men and women. JAMA. 2011;306(7):737–45.
Crivelli JJ, Xylinas E, Kluth LA, Rieken M, Rink M, Shariat SF. Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature. Eur Urol. 2014;65(4):742–54.
Grotenhuis AJ, Ebben CW, Aben KK, et al. The effect of smoking and timing of smoking cessation on clinical outcome in non-muscle-invasive bladder cancer. Urol Oncol. 2015;33(2):65.e69–17.
Allard P, Fradet Y, Tetu B, Bernard P. Tumor-associated antigens as prognostic factors for recurrence in 382 patients with primary transitional cell carcinoma of the bladder. Clin Cancer Res. 1995;1(10):1195–202.
Chen CH, Shun CT, Huang KH, et al. Stopping smoking might reduce tumour recurrence in nonmuscle-invasive bladder cancer. BJU Int. 2007;100(2):281–86; discussion 286.
Cheng L, Neumann RM, Weaver AL, Spotts BE, Bostwick DG. Predicting cancer progression in patients with stage T1 bladder carcinoma. J Clin Oncol. 1999;17(10):3182–87.
Fleshner N, Garland J, Moadel A, et al. Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder. Cancer. 1999;86(11):2337–45.
Gangawar R, Ahirwar D, Mandhani A, Mittal RD. Impact of nucleotide excision repair ERCC2 and base excision repair APEX1 genes polymorphism and its association with recurrence after adjuvant BCG immunotherapy in bladder cancer patients of North India. Med Oncol. 2010;27(2):159–66.
Gee JR, Jarrard DF, Bruskewitz RC, et al. Reduced bladder cancer recurrence rate with cardioprotective aspirin after intravesical bacille Calmette-Guerin. BJU Int. 2009;103(6):736–39.
Hwang EC, Kim YJ, Hwang IS, et al. Impact of diabetes mellitus on recurrence and progression in patients with non-muscle invasive bladder carcinoma: a retrospective cohort study. Int J Urol. 2011;18(11):769–76.
Lammers RJ, Witjes WP, Hendricksen K, Caris CT, Janzing-Pastors MH, Witjes JA. Smoking status is a risk factor for recurrence after transurethral resection of non-muscle-invasive bladder cancer. Eur Urol. 2011;60(4):713–20.
Rink M, Furberg H, Zabor EC, et al. Impact of smoking and smoking cessation on oncologic outcomes in primary non-muscle-invasive bladder cancer. Eur Urol. 2013;63(4):724–32.
Rink M, Xylinas E, Babjuk M, et al. Impact of smoking on outcomes of patients with a history of recurrent nonmuscle invasive bladder cancer. J Urol. 2012;188(6):2120–27.
Rink M, Xylinas E, Babjuk M, et al. Smoking reduces the efficacy of intravesical bacillus Calmette-Guerin immunotherapy in non-muscle-invasive bladder cancer. Eur Urol. 2012;62(6):1204–06.
Segal R, Yafi FA, Brimo F, Tanguay S, Aprikian A, Kassouf W. Prognostic factors and outcome in patients with T1 high-grade bladder cancer: can we identify patients for early cystectomy? BJU Int. 2012;109(7):1026–30.
Serretta V, Altieri V, Morgia G, Di Lallo A, Carrieri G, Allegro R. Cigarette smoking status at diagnosis and recurrence in intermediate-risk non-muscle-invasive bladder carcinoma. Urology. 2013;81(2):277–81.
Sfakianos JP, Shariat SF, Favaretto RL, Rioja J, Herr HW. Impact of smoking on outcomes after intravesical bacillus Calmette-Guerin therapy for urothelial carcinoma not invading muscle of the bladder. BJU Int. 2011;108(4):526–30.
Babjuk M, Burger M, Zigeuner R, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013;64(4):639–53.
Al-Mamgani A, van Rooij PH, Woutersen DP, et al. Radiotherapy for T1-2N0 glottic cancer: a multivariate analysis of predictive factors for the long-term outcome in 1050 patients and a prospective assessment of quality of life and voice handicap index in a subset of 233 patients. Clin Otolaryngol. 2013;38(4):306–12.
Benninger MS, Gillen J, Thieme P, Jacobson B, Dragovich J. Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinomas. Laryngoscope. 1994;104(3 Pt 1):294–98.
Zhou W, Heist RS, Liu G, et al. Smoking cessation before diagnosis and survival in early stage non-small cell lung cancer patients. Lung Cancer. 2006;53(3):375–80.
Sardari Nia P, Weyler J, Colpaert C, Vermeulen P, Van Marck E, Van Schil P. Prognostic value of smoking status in operated non-small cell lung cancer. Lung Cancer. 2005;47(3):351–59.
Videtic GM, Stitt LW, Dar AR, et al. Continued cigarette smoking by patients receiving concurrent chemoradiotherapy for limited-stage small-cell lung cancer is associated with decreased survival. J Clin Oncol. 2003;21(8):1544–49.
Chernyavsky AI, Shchepotin IB, Grando SA. Mechanisms of growth-promoting and tumor-protecting effects of epithelial nicotinic acetylcholine receptors. Int Immunopharmacol. 2015;29(1):36–44.
Momi N, Ponnusamy MP, Kaur S, et al. Nicotine/cigarette smoke promotes metastasis of pancreatic cancer through alpha7nAChR-mediated MUC4 upregulation. Oncogene. 2013;32(11):1384–95.
Schaal C, Chellappan SP. Nicotine-mediated cell proliferation and tumor progression in smoking-related cancers. Mol Cancer Res. 2014;12(1):14–23.
Improgo MR, Tapper AR, Gardner PD. Nicotinic acetylcholine receptor-mediated mechanisms in lung cancer. Biochem Pharmacol. 2011;82(8):1015–21.
Yuge K, Kikuchi E, Hagiwara M, et al. Nicotine induces tumor growth and chemoresistance through activation of the PI3K/Akt/mTOR pathway in bladder cancer. Mol Cancer Ther. 2015;14(9):2112–20.
Conflict of interest
Koichiro Ogihara, Eiji Kikuchi, Kazuyuki Yuge, Yujiro Ito, Nobuyuki Tanaka, Kazuhiro Matsumoto, Akira Miyajima, Hirotaka Asakura, and Mototsugu Oya certify that this study has no financial or other relationships that might lead to a conflict of interest.
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Ogihara, K., Kikuchi, E., Yuge, K. et al. Refraining from Smoking for 15 Years or More Reduced the Risk of Tumor Recurrence in Non-muscle Invasive Bladder Cancer Patients. Ann Surg Oncol 23, 1752–1759 (2016). https://doi.org/10.1245/s10434-015-5016-z
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DOI: https://doi.org/10.1245/s10434-015-5016-z