1589 INFLUENCE OF SMOKING HISTORY ON BLADDER CANCER PATIENT OUTCOME FOLLOWING RADICAL CYSTECTOMY

Abstract

INTRODUCTION AND OBJECTIVES: Smoking is a major risk factor for bladder cancer. However, effects of smoking on outcome of patients who have undergone cystectomy for bladder cancer is less clearly defined. This study used a large single-institution cohort to analyze the effects of prior exposure to cigarette smoke on prognosis following radical cystectomy. METHODS: 2,629 patients underwent radical cystectomy for bladder cancer at USC between 1983 and 2008. Study inclusion criteria were (a) presence of bladder transitional cell carcinoma without distant metastasis, (b) minimum 2 year post-cystectomy follow up if patient was alive, and (c) documented pre-cystectomy smoking history by patient interview. Smoker status was defined as non-light, former and current. Duration of regular smoking until diagnosis/quitting, and density of tobacco exposure as measured by number of cigarettes smoked daily were quantified. Associations with time to recurrence (TTR) and overall survival (OS) were analyzed using log-rank method and multivariate Cox regression models. RESULTS: 1,185 patients met the inclusion criteria. Median patient age was 67 years. Median follow up was 67.8 months during which 696 (59%) patients died; 321 (27%) patients died of bladder cancer. 273 (23%), 396 (33%), 260 (22%) and 256 (22%) patients had noninvasive, organ-confined, extravesical and node-positive disease, respectively. Increased age was prognostic for TTR (p 0.003) and OS (p 0.001). Increasing pathologic stage, lymph node density, presence of lymphovascular invasion, and adjuvant therapy administration were univariately associated with increased risk of recurrence and death (all p 0.001). Smoker status, duration of smoking, and number of cigarettes smoked daily were univariately associated with TTR (p 0.006, 0.005, and 0.015, respectively) and OS (p 0.001, 0.001, and 0.002, respectively). Following multivariate stratification, smoker status (p 0.04) and duration of smoking (p 0.04) were associated with TTR. Smoker status (p 0.001), duration of smoking (p 0.001), and number of cigarettes smoked daily (p 0.006) were also associated with OS. In particular, the relative risks of death for current smokers and patients who smoked 40 years were 1.18 and 1.15 times that of nonsmokers. CONCLUSIONS: Pre-cystectomy smoking habits influence survival following radical cystectomy. Current smokers and patients who smoke 40 years before diagnosis have a higher probability of death following radical cystectomy. Further work will examine the role of ongoing tobacco use on bladder cancer-specific mortality.