The aim of this study was to assess the influence of tobacco exposure, at the time of diagnosis, on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma (TCC) of the bladder.
METHODS.
A retrospective cohort study was performed using the MSKCC Registry to identify all institutional cases of "noninvasive" TCC (n Ο 1632) between 1985 and 1995. After employing exclusion criteria, 286 cases of incident tobacco-associated superficial TCC were divided into 3 strata of tobacco exposure (127 exsmokers, 51 quitters, and 108 continued smokers) by chart review and post hoc questionnaires (n Ο 82). Measured outcomes included recurrence free survival and survival free of adverse events (defined a priori as disease progression or other urinary tract TCC).
RESULTS.
There were no significant differences among ex-smokers, quitters, and continued smokers in terms of stage, grade, tumor size, multifocality, up-front bacillus Calmette-Gue Β΄rin therapy, or median follow-up. Ex-smokers presented at a later age than individuals who continued to smoke. Post hoc questionnaires and chart reviews were compared in terms of smoking status at time of diagnosis, and reliability was excellent ( Ο 0.89). Multivariate analyses revealed diminished recurrence free survival among continued smokers versus quitters or ex-smokers.
Univariate analyses revealed diminished adverse event free survival among continued smokers versus quitters or ex-smokers. Multivariate models assessing adverse event free survival revealed a similar trend (P Ο 0.06).
CONCLUSIONS.
Continued smokers experience worse disease-associated outcomes than patients who quit smoking. Smoking cessation should thus be employed as a tertiary prevention strategy for patients with superficial TCC. [