Smoking cessation and outcome of patients affected by non muscle invasive bladder cancer (NMI-BC)

Introduction: Does a correlation exist between smoking cessation and recurrence of non muscle invasive bladder carcinoma (NMI-BC) after TUR and adjuvant intravescical chemotherapy? Up today just few retrospective studies tried to answer this question. There is evidence that quitting decreases the risk of recurrence but nowadays it is still controversial how and how long it takes from quitting to reduce the risk (1-3). The aim of the present study is to compare the recurrence rate in smokers, non smokers and former smokers and in particular to evaluate if and how the decision of quitting at diagnosis could change the patients’outcome. Patients and Methods: We retrospectively analyzed the outcome in term of recurrence in patients affected by primary NMI-BC. Our population consisted of 373 patients, mean age of 66 (range 30-95) years. We considered as smokers the patients still smoking at the time of the diagnosis of primary NMI-BC, former smokers all the patients who quitted before diagnosis and never smokers all other patients. The smokers were divided into in current smokers continuing to smoke after diagnosis and ex smokers quitting only at diagnosis. The duration of smoking, the number of cigarettes per day and the clinical and pathological characteristic of the patients, were related to the recurrence rate. Results: Out of the 373 patients, 190 (50.9%) were smokers, 99 (26.5%) former smokers and 84 (22.5%) never smokers. Sixtyfive (17.4%) out of 190 smokers quitted at diagnosis. At 3 years 185 (49.6%) patients recurred. During follow up the recurrence rate increased from 11,3% at 3 months to 49.6% at 36 months. The recurrence rates at 3 and 6 months were higher in former smokers, 17.2% and 24.2% respectively, than in never smokers, 9.5% and 19% and smokers 9% and 21%. At one year, 75 (39.5%) smokers, 35 (35.3%) former smokers and 29 (34.5%) never smokers recurred. Among smokers at 3 months 5 (7.7%) ex smokers and 12 (9.6%) current smokers, (p=0.79) recurred; and at 6 months 13 (20%) and 27 (21.4%) recurred respectively (p=0.85). Similar results were observed at one year, with 23 (35%) ex smokers and 51 (40%) current smokers recurring (p=0.87) while at 3 years 29 (44.6%) ex smokers and 68 (54%) smokers (p=0.22) recurred. A progressive increase in recurrence rate, particularly in current smokers was observed, not reaching statistical significance due to the small numbers of our preliminary study. Discussion and Conclusion: In patients with non muscle invasive bladder cancer former smokers and smokers have similar recurrence rates. However to stop smoking at diagnosis reduces the risk of recurrence compared to patients continuing to smoke. The benefit however appears after 12 months only. References 1 Aveyard P, Adab P, Cheng KK et al: Does smoking status influence the prgnosis of bladder cancer? A systematic review. BJU Int 90: 228-239, 2002. 2 Serretta V, Morgia G, Altieri V et al: A 1-year maintenance after early adjuvant intravescical chemotherapy has a limited efficacy in preventing recurrence of intermediate risk non- muscle-invasive bladder cancer. Brit J Urol Int 106: 212-217, 2010. 3 Chen CH, Shun CT, Huang KH et al. Stopping smoking might reduce tumour recurrence in non muscle-invasive bladder cancer. BJU Int 100(2): 281-286, 2007.