Cigarette Smoking Status at Diagnosis and Recurrence in Intermediate-risk Nonemuscle-invasive Bladder Carcinoma

Objective: To study the effect of smoking status at diagnosis on recurrence in intermediate risk (IR) non-muscle invasive bladder carcinoma (NMIBC) treated by TUR and early intravesical chemotherapy. Methods: Tumor characteristics and smoking status were recorded in 395 patients entered in a randomized multicenter trial comparing two different schedules of early intravesical chemotherapy. All patients received intravesical epirubicin (80mg/50 ml) within 6 hours after TUR followed by 5 more weekly instillations with (Arm B) or without (Arm A) monthly instillations for one year. Smoking habit was investigated at diagnosis through a structured questionnaire. Multivariate statistical analysis was performed to study the recurrence-free survival (RFS) and the recurrence-free rate (RFR) in relation to smoking status. Results: Nine-seven (24,6%) patients never smoked and 298 (75,4%) were smokers. At a median follow-up of 48 months, 117 patients (29.6%) recurred, 63 in arm A and 54 in arm B (p=0.43). Ten patients (2.5%) progressed. The 3-year RFS, RFR and median time to first recurrence of smokers and patients who never smoked were 64.0% and 71.3% (p.=0.08), 69.1% and 74.2% (p.=0.16) and 13.6 and 14.2 months (p.=0.27) respectively. The multivariate analysis identified the previous history (p.=0.01) and the smoking status (p.=0.04) as the main prognostic factors for recurrence in this category of patients. No difference in recurrence risk at 3 years was detected between current and former smokers Conclusions: In intermediate risk NMIBC treated by early intravesical chemotherapy the smoking status influences significantly the 3-year RFS. No difference was detected between current and former smokers.