Stopping smoking might reduce tumour recurrence in nonmuscle‐invasive bladder cancer

Abstract

OBJECTIVE To evaluate effects of stopping smoking on the outcome of nonmuscle‐invasive bladder cancer, as cigarette smoking is a risk factor for bladder cancer and little is known about whether stopping smoking reduces the risk of recurrence or progression. PATIENTS AND METHODS Between January 1997 and July 2005, 297 men with primary nonmuscle‐invasive bladder cancer were treated with transurethral resection (TUR); their smoking status before and after the diagnosis of bladder cancer was obtained by a post hoc questionnaire and interview. ‘Quitters’ were those who ceased smoking within a year before and 3 months after the diagnosis. Ex‐smokers were those who ceased smoking more than a year before diagnosis. Several pathological and clinical variables were compared, with all statistical comparisons being two‐sided. RESULTS In all, 265 patients completed the questionnaire, including 64 non‐smokers, 64 ex‐smokers, 59 quitters, and 78 continued smokers. The median follow‐up was 38 months. There were no significant differences in the strata of stage, grade, tumour multiplicity, intravesical therapy, or median follow‐up duration between the four patient groups. The respective 3‐year recurrence‐free survival of continued smokers, non‐smokers, ex‐smokers and quitters was 45%, 57%, 62% and 70%. By multivariate analysis, high‐grade, T1‐stage, multiple tumours and continued smoking were significant independent predictors for a shorter recurrence‐free survival. Quitters had a lower risk of recurrence than did either continued smokers or non‐smokers, but had a similar risk to ex‐smokers. CONCLUSION Stopping smoking might be associated with a lower recurrence rate for patients with nonmuscle‐invasive bladder cancer.

Nicotine Induces Tumor Growth and Chemoresistance through Activation of the PI3K/Akt/mTOR Pathway in Bladder Cancer

“…As shown in Fig. 4A, on day 21, tumor volume (mean AE SE) in mice treated with CDDP but without nicotine was 231.5 AE 53.8 mm 3 , which was significantly smaller than that in mice treated only with vehicle control (489.1 AE 73.4 mm 3 , P ¼ 0.010). Furthermore, mean tumor volume after CDDP treatment in mice injected with nicotine was 492.6 AE 78.5 mm 3 , which was significantly larger than that in mice treated with CDDP but without nicotine (P ¼ 0.015).…”

“…Drug administration was started when average tumor volume was approximately 150 mm 3 and that day was defined as day 1. Nicotine was administered intraperitoneally 3 times a week.…”

“…The animals were carefully monitored, and the tumor was measured twice a week. Tumor volume was calculated using the following formula: tumor volume (mm 3 ) ¼ length  width  height  0.52.…”

“…Recent studies have demonstrated that smoking status is associated not only with tumor incidence but also with the subsequent clinical outcome of bladder cancer and upper tract urothelial carcinoma (UTUC; refs. [3][4][5][6]. Lammers and colleagues showed that exsmokers and current smokers had a significantly shorter recurrence-free survival than nonsmokers after transurethral resection of non-muscle-invasive bladder cancer (7).…”

Epidemiology of urothelial carcinoma

“…39 Smoking cessation also appears to decrease the recurrence rate for patients with non-muscle-invasive bladder cancer even after the diagnosis. 40 In both men and women, the onset of bladder cancer is approximately 6 years earlier (6.1 years in men and 5.9 years in women) for current smokers than for current non-smokers. 41 At the time of diagnosis, the tumor stage was significantly higher in the current smokers group.…”