SMOKING STATUS, RECURRENCE RISK AND INTRAVESICAL CHEMOTHERAPY IN NONMUSCLE- INVASIVE BLADDER CANCER

Background and Aim: The influence of smoking status on the diagnosis of carcinoma of the bladder, on recurrence risk Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy and response to intravesical treatment has been scarcely studied. Available studies suggest a reduction in recurrence risk with cessation of smoking, however, most studies lack sufficient statistical power. The aim of the present analysis was to study the recurrence risk and the response to intravesical chemotherapy in terms of recurrence-free rate (RFR) and recurrence-free survival (RFS) in relation to smoking status at diagnosis in patients affected by intermediate-risk non-muscle invasive carcinoma of the bladder (NMI-BC). Patients and Methods: Tumor characteristics and smoking status were recorded for patients affected by NMI-BC treated by transurethral resection (TUR) and adjuvant intravesical therapy. All patients received intravesical epirubicin within six hours of TUR at a dose of 80 mg diluted in 50 ml of saline solution. Further adjuvant treatment in low- and high-risk patients was given according to physicians’ choice. Two different schemes of intravesical chemotherapy with epirubicin were adopted at a dose of 80 mg in 50 ml for patients at intermediate risk. All patients were submitted to cytology and cystoscopy at three-monthly intervals for two years and then at six-monthly intervals for three more years. Multivariate statistical analysis was conducted to study the recurrence risk and the response to intravesical chemotherapy in terms of RFR and RFS in relation to smoking status at diagnosis. Results: Out of 577 consecutive patients, 241 (42%), 188 (33%) and 148 (25%) were current, former and never smokers, respectively. The mean number of cigarettes smoked per day was 20 for a median period of 30 years. Recurrent tumors were statistically more frequent in smokers that in never smokers. The percentage of recurrence increased from 20% to 42% (p<0.0001) for these who smoked less than 30 years compared to those who had smoked for longer. No significant difference between current and former smokers emerged in terms of RFR and RFS at a median follow-up of four years. On the other hand, a significant difference in terms of RFS between never and former smokers was evident (p=0.019). The 3-year RFS in never and former smokers was 71.3% and 57.6%, respectively. The above mentioned difference was completely removed 20 years after smoking cessation. An advantage in terms of RFR at 12 months emerged in favor of prolonged intravesical chemotherapy only in current smokers. Conclusion: Recurrent tumors are more frequent in smokers than in never smokers. Duration of smoking has a relevant impact on RFR. A significant difference in terms of RFS between never and former smokers was evident but the difference was completely removed 20 years after cessation of smoking. No statistically significant difference between current and former smokers emerged in our analysis. A statistically significant benefit from prolonged intravesical chemotherapy in terms of RFR emerged in current smokers only.