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Prognostic Impact of Post-Diagnosis Smoking Cessation among Bladder Cancer Patients: A Systematic Literature Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14164022. [PMID: 36011016 PMCID: PMC9406768 DOI: 10.3390/cancers14164022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
We reviewed the studies examining whether quitting smoking at or around diagnosis favourably affects the prognosis of bladder cancer (BC) patients, who are often active smokers at diagnosis. We found only nine eligible articles published until 31 January 2022, which encompassed around 5500 BC in total, the majority of which were nonmuscle invasive BC (only one paper included muscle-invasive BC). We used random effects meta-analysis to obtain a summary hazard ratio (SHR) and 95% confidence intervals (CI). The median proportion of smokers who quit at or around diagnosis was 29.8% (range 8.4-43.1%). For the overall, BC-specific, and progression-free survival, the studies were limited in number (n = 3) and provided conflicting results. At the same time, quitters did not appear to have a lower risk of recurrence than continued smokers (SHR 0.99, 95% CI 0.61-1.61). In conclusion, while the evidence is currently not sufficient to draw firm conclusions (especially for patients with muscle-invasive BC), physicians should not refrain from educating smoking BC patients about the benefits of smoking cessation and provide the necessary support.
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Schaefers C, Seidel C, Bokemeyer F, Bokemeyer C. The prognostic impact of the smoking status of cancer patients receiving systemic treatment, radiation therapy, and surgery: A systematic review and meta-analysis. Eur J Cancer 2022; 172:130-137. [PMID: 35763872 DOI: 10.1016/j.ejca.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cigarette smoking represents the main risk factor for cancer development; however, less is known about the effects of active smoking on the outcome of cancer patients receiving systemic treatment, radiation therapy, or surgery. METHODS A systematic review and meta-analysis were conducted searching the PubMed® and Web of Science® Library databases using specific Medical Subject Headings terms. Studies reporting on the prognostic impact of the smoking status concerning survival endpoints in cancer patients treated with systemic treatment, radiation therapy, or surgery were eligible for inclusion. RESULTS Of 1.380 articles reviewed, 12 reports including data from 31.785 patients with six different cancer types were considered eligible for inclusion. According to the meta-analysis of the overall effect, active smoking during cancer treatment was associated with an impaired overall survival (OS) and cancer-specific mortality (CSM) as compared to former or never smokers (OS: hazard ratio (HR) = 1.61, 95% CI: 1.19-2.17, p = 0.007; CSM: HR = 1.25, 95% CI: 1.01-1.54, p = 0.046). Moreover, smoking cessation led to a similar OS and CSM when comparing former to never smoking patients (OS: HR = 1.01, 95% CI: 0.87-1.18, p = 0.818; CSM: HR = 1.04, 95% CI: 0.91-1.20, p = 0.324). CONCLUSION These results underline active smoking during cancer treatment as an independent adverse prognostic factor, while smoking cessation can result in similar outcomes compared to never smokers. Limitations of the study were a substantial study heterogeneity concerning different cancer entities and variations of treatment modalities.
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Affiliation(s)
- Christoph Schaefers
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany.
| | - Frederike Bokemeyer
- Department of Medical Psychology, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Hamburg, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany
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Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge regarding the relationship between smoking and bladder cancer (BCa), especially with respect to treatment outcomes for muscle and nonmuscle-invasive BCa (MIBC/NMIBC). RECENT FINDINGS PubMed/Medline databases were searched for recent reports investigating the association of smoking with BCa. Smoking is associated with an increased risk of recurrence in patients with NMIBC and may impair Bacillus Calmette-Guerin treatment efficacy. Moreover, smoking is associated with poor responses to neoadjuvant chemotherapy, poor survival outcomes and high complication rates in patients undergoing radical cystectomy. Smoking cessation mitigates these negative effects, especially. However, the amount of patient counselling provided regarding this important matter and patient knowledge regarding smoking and BCa risk are inadequate. Currently, the impact of secondhand smoke on BCa risk remains uncertain. SUMMARY Tobacco smoking is responsible for approximately half of BCa cases, and is associated with poor oncological outcomes for both NMIBC and MIBC. Despite smoking being a well known risk factor, counselling and knowledge in this area are insufficient. Appropriate smoking cessation interventions and patient information are required to improve patient health and optimize BCa survival.
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Gild P, Vetterlein MW, Seiler R, Necchi A, Hendricksen K, Mertens LS, Roghmann F, Landenberg NV, Gontero P, Cumberbatch M, Dobruch J, Seisen T, Grande P, D'Andrea D, Anract J, Comploj E, Pycha A, Saba K, Poyet C, van Rhijn BW, Noon AP, Roupret M, Shariat SF, Fisch M, Xylinas E, Rink M. The association of cigarette smoking and pathological response to neoadjuvant platinum-based chemotherapy in patients undergoing treatment for urinary bladder cancer - A prospective European multicenter observational study of the EAU Young Academic Urologists (YAU) urothelial carcinoma working group. Surg Oncol 2020; 34:312-317. [PMID: 32891350 DOI: 10.1016/j.suronc.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/18/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To prospectively study the impact of smoking on pathological response to neoadjuvant chemotherapy (NAC) in patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). MATERIALS & METHODS We collected standard clinicopathological variables, including smoking status (never, former, current) in patients undergoing NAC and RC for UCB at 12 European tertiary care centers between 12/2013-12/2015. Clinicopathological variables were compared according to smoking status. Multivariable logistic regression models were built to assess the association of smoking status and a) complete (no residual disease), b) partial (residual, non-muscle invasive disease), c) no pathological response (residual muscle invasive or lymph node positive disease). Kaplan-Meier and Cox regression analyses were employed to study the impact of response to NAC on survival. RESULTS AND LIMITATIONS Our final cohort consisted of 167 NAC patients with a median follow-up of 15 months (interquartile range (IQR) 9-26 months) of whom 48 (29%), 69 (41%), and 50 (30%) where never, former, and current smokers, respectively. Smoking was significantly associated with advanced age (p = 0.013), worse ECOG performance status (p = 0.049), and decreased pathological response to NAC (p = 0.045). On multivariable logistic regression analyses, former and current smoking status was significantly associated with lower odds of complete pathological response (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.16-0.87, p = 0.023, and OR 0.34, 95% CI 0.13-0.85, p = 0.021), while current smoking status was significantly associated with a greater likelihood of no pathological response (OR 2.49, 95% CI 1.02-6.06, p = 0.045). Response to NAC was confirmed as powerful predictor of survival. CONCLUSIONS Smoking status is adversely associated with pathological response to NAC. Smokers should be informed about these adverse effects, counseled regarding smoking cessation, and possibly be considered for immunotherpeutics as they may be more effective in smokers.
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Affiliation(s)
- Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Germany
| | - Roland Seiler
- Department of Urology, University Hospital Berne, Berne, Switzerland
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | | | - Paolo Gontero
- Department of Surgical Sciences, University of Torino, Italy
| | | | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Thomas Seisen
- Department of Urology, University Paris Sorbonne, France
| | - Pietro Grande
- Department of Urology, University Paris Sorbonne, France
| | - David D'Andrea
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - Julien Anract
- Department of Urology, Bichat-Claude Bernard Hospital, Paris Descartes University, Paris, France
| | - Evi Comploj
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy; Department of Research, College of Health Care Professions, Claudiana, Bozen, Italy
| | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy; Medical School, Sigmund Freud University, Vienna, Austria
| | - Karim Saba
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Cedric Poyet
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Bas W van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Aidan P Noon
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Morgan Roupret
- Department of Urology, University Paris Sorbonne, France
| | - Shahrokh F Shariat
- Department of Urology, Medical University Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Germany
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Paris Descartes University, Paris, France
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Germany.
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Yip W, Cacciamani G, Bhanvadia SK. Disparities in Bladder Cancer Outcomes Based on Key Sociodemographic Characteristics. Curr Urol Rep 2020; 21:24. [PMID: 32377877 DOI: 10.1007/s11934-019-0950-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW A review of the impact of several key patient characteristics on oncologic outcomes in bladder cancer (BC) summarized and analyzed in a narrative fashion. RECENT FINDINGS The bulk of the published literature suggests that females and blacks have poorer cancer-specific outcomes. Both groups tend to present with worse disease, which may be driven by differences in access to timely and quality care. Attempts to assess the association between smoking status and history and BC outcomes have been hindered by the quality and heterogeneity of the data, although several studies have linked smoking with higher rates of recurrence and poorer survival. Being married, particularly in men, may improve survival after radical cystectomy (RC). Limited data suggests that socioeconomic and education levels may be associated with poorer survival; however, the data is limited. A growing body of investigation suggests that there are significant differences in oncologic outcomes in BC patients based on race, gender, smoking status, socioeconomic status, and others. Further focus and investigation is needed to validate these findings, investigate the root cause of these differences, and offer solutions to mitigate them.
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Affiliation(s)
- Wesley Yip
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA
| | - Giovanni Cacciamani
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA
| | - Sumeet K Bhanvadia
- USC Institute of Urology, Keck School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave, Suite 7416, Los Angeles, CA, 90033, USA.
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Zuniga KB, Graff RE, Feiger DB, Meng MV, Porten SP, Kenfield SA. Lifestyle and Non-muscle Invasive Bladder Cancer Recurrence, Progression, and Mortality: Available Research and Future Directions. Bladder Cancer 2020; 6:9-23. [PMID: 34095407 PMCID: PMC8174672 DOI: 10.3233/blc-190249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND: A broad, comprehensive review of studies exploring associations between lifestyle factors and non-muscle invasive bladder cancer (NMIBC) outcomes is warranted to consolidate recommendations and identify gaps in research. OBJECTIVE: To summarize the literature on associations between lifestyle factors and clinical outcomes among patients with NMIBC. METHODS: PubMed was systematically queried for articles published through March 2019 regarding lifestyle factors and recurrence, progression, cancer-specific mortality, and all-cause mortality among patients with NMIBC. RESULTS: Notwithstanding many ambiguities, there is good-quality evidence suggesting a benefit of smoking avoidance/cessation, healthy body mass index (BMI), and type II diabetes mellitus prevention and treatment. Lactobacillus casei probiotic supplementation may reduce recurrence. There have been individual studies suggesting a benefit for uncooked broccoli and supplemental vitamin E as well as avoidance of supplemental vitamin B9, areca nut chewing, and a “Western diet” pattern high in fried foods and red meat. Additional studies do not suggest associations between NMIBC outcomes and use of fibrin clot inhibitors; insulin and other oral hypoglycemics; statins; supplemental selenium, vitamin A, vitamin C, and vitamin B6; fluid intake and intake of specific beverages (e.g., alcohol, coffee, green tea, cola); various dietary patterns (e.g., Tex-Mex, high fruit and vegetable, low-fat); and occupational and chemical exposures. CONCLUSIONS: Despite a myriad of publications on lifestyle factors and NMIBC, a need remains for research on unexplored associations (e.g., physical activity) and further studies that can elucidate causal effects. This would inform future implementation strategies for healthy lifestyle change in NMIBC patients.
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Affiliation(s)
- Kyle B Zuniga
- Department of Urology, University of California, San Francisco, CA, USA.,Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.,College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - David B Feiger
- Department of Urology, University of California, San Francisco, CA, USA.,School of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maxwell V Meng
- Department of Urology, University of California, San Francisco, CA, USA
| | - Sima P Porten
- Department of Urology, University of California, San Francisco, CA, USA
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, CA, USA
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Abstract
PURPOSE OF REVIEW Whether prehabilitation in radical cystectomy adds to the effort of reducing postoperative morbidity and impairments in the survivorship phase has until recently received limited attention. This narrative review aims to summarize the current evidence base on prehabilitaion interventions focusing on the efficacy of procedure-specific interventions and the influence on postoperative outcomes. RECENT FINDINGS Given the oncological risk, there is a relative short window to intervene and proactively optimize the patient before radical cystectomy. Preliminary results are however promising and a single-center randomized controlled trial (RCT) has shown that home-based short-term physical prehabilitation is feasible and effective and significantly improves early mobilization, time to perform activities of daily living and health-related quality of life (HRQoL). No significant impact on length of stay or complications was found. Limited evidence support preoperative nutritional interventions in cancer surgery, although evidence suggests improved outcome if malnourished individuals are adequately fed 7-10 days before surgery. No RCTs have evaluated the effect of smoking or alcohol cessation interventions on complications or HRQoL in radical cystectomy. Patient education interventions focusing on stoma care improve significantly self-efficacy in regards to independently change of stoma-appliance up to 1 year postoperatively. Currently, there is no evidence of early intervention considering psychological well being, sexual health or shared decision-making. SUMMARY Published data indicate that a group of preoperative multiprofessional interventions including physical exercises, supportive nutritional care and stoma education can postoperatively improve early mobilization, self-efficacy and HRQoL. No evidence for further reduction of length of stay or complications was found.
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A Novel Risk-based Approach Simulating Oncological Surveillance After Radical Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2019; 3:756-763. [PMID: 31395480 DOI: 10.1016/j.euo.2019.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current guideline lacks evidence for creating individualized surveillance strategies for upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). OBJECTIVE To create a novel risk model and to simulate individualized surveillance duration that dynamically illustrates the changing risk relationship of UTUC-related death and non-UTUC death, considering the impact of cigarette smoking. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study comprised 714 pTa-T4N0M0 UTUC patients, with a median follow-up duration of 65mo. There were 279 (39.1%) nonsmokers, 260 (36.4%) current smokers, and 175 (24.5%) ex-smokers. INTERVENTION All patients underwent RNU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The risks of UTUC death and non-UTUC death over time were estimated using parametric models for time to failure with Weibull distributions. Age-specific, stage-specific, and smoking status-specific surveillance durations were simulated based upon Weibull estimates. RESULTS AND LIMITATIONS The hazard rate (HR) of non-UTUC death gradually increased over time in all age groups regardless of the smoking status, whereas that of UTUC-related death decreased markedly according to the pathological T (pT) stage and was affected by the smoking status. Among current smokers, the baseline HR of UTUC-related death in pT3/4 was higher than that of pT ≤2 and remained high even 10yr after RNU. Among heavy smokers, the HR of UTUC-related death in all pT stages was highest at baseline and remained high after RNU, compared with nonsmokers, current smokers, or ex-smokers. We simulated specific time points when the risk of non-UTUC death was greater than that of UTUC-related death. Among patients ≥80yr of with pT3N0M0, the risk of non-UTUC death was greater than that of UTUC-related death 1yr after RNU in nonsmokers, but 7yr for heavy smokers. CONCLUSIONS Our result revealed that smokers bear a long-term risk burden of UTUC-related death more than the risk of non-UTUC death. For UTUC smokers, longer-term surveillance duration is recommended even in elderly stage. PATIENT SUMMARY In the present study, we evaluated the risk transition of upper tract urothelial carcinoma (UTUC)-related death and non-cancer-related death over time. We found that smoking weighed a huge impact upon UTUC-related death compared with death from other cause, and therefore, we created a more individualized surveillance duration model.
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Boeri L, Soligo M, Frank I, Boorjian SA, Thompson RH, Tollefson M, Quevedo FJ, Cheville JC, Karnes RJ. Cigarette smoking is associated with adverse pathological response and increased disease recurrence amongst patients with muscle-invasive bladder cancer treated with cisplatin-based neoadjuvant chemotherapy and radical cystectomy: a single-centre experience. BJU Int 2019; 123:1011-1019. [PMID: 30623554 DOI: 10.1111/bju.14612] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the association between smoking status and pathological response to cisplatin-based neoadjuvant chemotherapy (NAC) and survival outcomes in patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy (RC). PATIENTS AND METHODS We reviewed 201 patients treated with NAC and RC for cT2-cT4N0M0 BC between 01/1999 and 01/2015. Smoking status was categorised as: 'never', 'former', and 'current' smoker. Pathological response to NAC was defined as: complete (ypT0N0), partial (ypTis/Ta/T1, N0), and no response (ypT2-4 or ypN+). Clinicopathological characteristics were analysed according to smoking status. Logistic regression analyses tested the association between smoking status and pathological response to NAC. Cox regression analyses tested risk factors associated with recurrence, overall (OM) and cancer-specific mortality (CSM). RESULTS Overall, there were 58 (28.9%) never smokers, 87 (43.3%) former smokers, and 56 (27.9%) current smokers. No response to NAC was more frequently noted in current smokers (73.2%; P = 0.007). Former smoker (odds ratio [OR] 2.28; P = 0.024) and current smoker statuses (OR 4.52; P < 0.001) were significantly associated with no response to NAC, after adjusting for age, gender, Charlson Comorbidity Index, and clinical stage. Similarly, current smoking status (hazard ratio [HR] 2.14; P = 0.03) and extravesical pathological tumour stage (HR 3.31; P < 0.001) were independently associated with an increased risk of recurrence after RC. CONCLUSION Cigarette smoking was significantly associated with adverse pathological response to cisplatin-based NAC in patients with MIBC treated with RC. Current smokers were at significantly higher risk of disease recurrence as compared to former and never smokers.
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Affiliation(s)
- Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN, USA.,Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Soligo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Abstract
PURPOSE OF REVIEW To summarize the current knowledge about smoking carcinogenesis in bladder cancer (BCa), individual susceptibility and impact of smoking on incidence and outcomes of nonmuscle invasive BCa (NMIBC) and muscle-invasive BCa (MIBC). To assess the impact of smoking cessation on oncological outcomes. RECENT FINDINGS Smoking pattern, intensity, and duration are responsible for an increased risk of developing BCa and for worse tumor features at presentation. Tobacco consumption is associated with a higher risk of recurrence in NMIBC and with an impaired intravesical therapy efficacy. To date, the impact of smoking on oncological outcomes after radical surgery remains unclear. SUMMARY Smoking cessation decreases the risk of BCa and may also allow benefits on treatment outcomes. Nonetheless, the magnitude of the effect remains unclear and prospective series with the specific aim of weighing smoking cessation on outcomes are needed. Because even a 5-min counseling in the urology setting may be sufficient to significantly enhance smoking cessation rates, adequate knowledge of links between tobacco and BCa, from its molecular pathophysiology and its harms to benefits of cessation is paramount for urologists and for everyday clinical practice.
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Froehner M, Koch R, Hübler M, Heberling U, Novotny V, Zastrow S, Baretton GB, Wirth MP. Selection Effects May Explain Smoking-related Outcome Differences After Radical Cystectomy. Eur Urol Focus 2018; 4:395-398. [DOI: 10.1016/j.euf.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/02/2016] [Accepted: 10/11/2016] [Indexed: 12/01/2022]
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12
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Hou L, Hong X, Dai M, Chen P, Zhao H, Wei Q, Li F, Tan W. Association of smoking status with prognosis in bladder cancer: A meta-analysis. Oncotarget 2018; 8:1278-1289. [PMID: 27902481 PMCID: PMC5352054 DOI: 10.18632/oncotarget.13606] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/12/2016] [Indexed: 01/11/2023] Open
Abstract
There is considerable controversy regarding the association between smoking and prognosis in surgically treated bladder cancer. The present meta-analysis was performed to quantify the role of smoking status in bladder cancer recurrence, progression and patient survival by pooling the available previous data. Pubmed, Embase and the Cochrane Library databases were searched for eligible studies published prior to April 2016. Random and fixed effects models were used to calculate the summary relative risk estimates (SRRE). A total of 10,192 patients from 15 studies were included in the meta-analysis. There was evidence of positive associations between current smoking and the risk of recurrence (SRRE=1.23; 95% CI, 1.05–1.45) and mortality (SRRE=1.28; 95% CI, 1.07-1.52) in bladder cancer. Furthermore, former smoking had positive associations with bladder cancer recurrence (SRRE=1.22; 95% CI, 1.09-1.37) and mortality (SRRE=1.20; 95% CI, 1.03-1.41). However, there was no significant association between bladder cancer progression risk and current (SRRE=1.11; 95% CI, 0.71-1.75) or previous smoking (SRRE=1.16; 95% CI, 0.92-1.46). The findings indicate that current and former smoking increase the risk of recurrence and mortality in patients with bladder cancer. However, due to the nonrandomized and retrospective nature of the current study, patients may be prone to potential selection bias. Prospective and larger epidemiological studies with a longer follow-up are required to confirm these findings.
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Affiliation(s)
- Lina Hou
- Department of Healthy Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China
| | - Xuwei Hong
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R.China
| | - Meng Dai
- Department of Healthy Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China
| | - Pengliang Chen
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R.China
| | - Hongfan Zhao
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R.China
| | - Qiang Wei
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R.China
| | - Fei Li
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R.China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R.China
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13
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Mari A, Campi R, Tellini R, Gandaglia G, Albisinni S, Abufaraj M, Hatzichristodoulou G, Montorsi F, van Velthoven R, Carini M, Minervini A, Shariat SF. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol 2017; 36:157-170. [PMID: 29147759 PMCID: PMC5799348 DOI: 10.1007/s00345-017-2115-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To review the currently available literature reporting the patterns of recurrence and their predictive factors after open radical cystectomy (RC) for bladder cancer. Methods A review of the literature was performed using the MEDLINE, Scopus and Web of Sciences databases from January 1997 to May 2017. The PRISMA guidelines were followed for the conduct of the study. Results Local recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%. The mean follow-up of studies included in the analysis ranged from 18 to 350 months. Details on the most important demographic and epidemiological, clinical, histologic and pathologic predictors of recurrence after radical cystectomy are provided through an evidence-based approach. The impact of the extension of lymph node dissection on recurrence after RC is investigated. Conclusions A correct prognostic assessment is essential for patients undergoing radical cystectomy for bladder cancer, thereby potentially improving their oncologic outcomes. Electronic supplementary material The online version of this article (10.1007/s00345-017-2115-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Simone Albisinni
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Roland van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria. .,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. .,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA. .,Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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14
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Gottlieb J, Higley C, Sosnowski R, Bjurlin MA. Smoking-related genitourinary cancers: A global call to action in smoking cessation. Rev Urol 2017; 18:194-204. [PMID: 28127261 DOI: 10.3909/riu0729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Smoking is a known modifiable risk factor in the development of genitourinary malignancies. Although the association has long been supported by numerous research studies, the impact of smoking cessation on the decreased risk of genitourinary malignancies is less well studied. PubMed databases were searched using the terms smoking, smoking cessation, bladder cancer, kidney cancer, prostate cancer, penile cancer, testicular cancer, their synonyms, and also targeted manual searches to perform a literature review in order to summarize the benefits of cessation on disease progression and patient outcomes including survival and morbidities. Our review yielded substantial evidence highlighting the improved outcomes observed in those diagnosed with bladder, renal, and prostate cancers. The risk of bladder cancer is reduced by up to 60% in those who were able to quit for 25 years and the risk of kidney malignancy was reduced by 50% in those who abstained from smoking for 30 years. A similar trend of reduced risk was observed for prostate cancer with those who quit for more than 10 years, having prostate cancer mortality risks similar to those that never smoked. Although the data were encouraging for bladder, renal, and prostate malignancies, there are comparatively limited data quantifying the benefits of smoking cessation for penile and testicular cancers, highlighting an opportunity for further study. The role of urologists and their impact on their patients' likelihood to quit smoking shows more than half of urologists never discuss smoking cessation upon diagnosis of a malignancy. Most urologists said they did not provide cessation counseling because they do not believe it would alter their patients' disease progression. Studies show urologists have more influence at changing their patients' smoking behaviors than their primary care physicians. The diagnosis of cancer may lead to a teachable moment resulting in increased smoking quit rates. Furthermore, implementing a brief 5-minute clinic counseling session increases quit attempts and quit rates. Diagnosis of genitourinary cancers and the following appointments for treatment provide a unique opportunity for urologists to intervene and affect the progression and outcome of disease.
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Affiliation(s)
- Josh Gottlieb
- New York Institute of Technology College of Osteopathic Medicine Old Westbury, NY
| | - Cory Higley
- New York Institute of Technology College of Osteopathic Medicine Old Westbury, NY
| | - Roman Sosnowski
- Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Warsaw, Poland
| | - Marc A Bjurlin
- Division of Urology, Department of Surgery, NYU Lutheran Medical Center, NYU School of Medicine, NYU Langone Health System New York, NY
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15
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Wilcox AN, Silverman DT, Friesen MC, Locke SJ, Russ DE, Hyun N, Colt JS, Figueroa JD, Rothman N, Moore LE, Koutros S. Smoking status, usual adult occupation, and risk of recurrent urothelial bladder carcinoma: data from The Cancer Genome Atlas (TCGA) Project. Cancer Causes Control 2016; 27:1429-1435. [PMID: 27804056 DOI: 10.1007/s10552-016-0821-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Tobacco smoking and occupational exposures are the leading risk factors for developing urothelial bladder carcinoma (UBC), yet little is known about the contribution of these two factors to risk of UBC recurrence. We evaluated whether smoking status and usual adult occupation are associated with time to UBC recurrence for 406 patients with muscle-invasive bladder cancer submitted to The Cancer Genome Atlas (TCGA) project. METHODS Kaplan-Meier and Cox proportional hazard methods were used to assess the association between smoking status, employment in a high-risk occupation for bladder cancer, occupational diesel exhaust exposure, and 2010 Standard Occupational Classification group and time to UBC recurrence. RESULTS Data on time to recurrence were available for 358 patients over a median follow-up time of 15 months. Of these, 133 (37.2%) experienced a recurrence. Current smokers who smoked for more than 40 pack-years had an increased risk of recurrence compared to never smokers (HR 2.1, 95% CI 1.1, 4.1). Additionally, employment in a high-risk occupation was associated with a shorter time to recurrence (log-rank p = 0.005). We found an increased risk of recurrence for those employed in occupations with probable diesel exhaust exposure (HR 1.8, 95% CI 1.1, 3.0) and for those employed in production occupations (HR 2.0, 95% CI 1.1, 3.6). CONCLUSIONS These findings suggest smoking status impacts risk of UBC recurrence, although several previous studies provided equivocal evidence regarding this association. In addition to the known causal relationship between occupational exposure and bladder cancer risk, our study suggests that occupation may also be related to increased risk of recurrence.
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Affiliation(s)
- Amber N Wilcox
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Debra T Silverman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Melissa C Friesen
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Sarah J Locke
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Daniel E Russ
- Division of Computational Bioscience, Department of Health and Human Services, Center for Information Technology, National Institutes of Health, Bethesda, MD, USA
| | - Noorie Hyun
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Joanne S Colt
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Jonine D Figueroa
- Usher Institute of Population Health Sciences and Informatics, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Nathaniel Rothman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Lee E Moore
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Rockville, MD, USA.
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16
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van Osch FHM, Jochems SHJ, van Schooten FJ, Bryan RT, Zeegers MP. Significant Role of Lifetime Cigarette Smoking in Worsening Bladder Cancer and Upper Tract Urothelial Carcinoma Prognosis: A Meta-Analysis. J Urol 2015; 195:872-9. [PMID: 26523878 DOI: 10.1016/j.juro.2015.10.139] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Although cigarette smoking is a well established risk factor for urothelial cancer, its role in urothelial cancer prognosis is still undetermined. In this meta-analysis we quantify the role of lifetime smoking history in bladder cancer recurrence, progression and survival by pooling available data on nonmuscle invasive bladder cancer, muscle invasive bladder cancer and upper tract urothelial carcinoma. MATERIALS AND METHODS A total of 24 studies, comprising data from 13,114 patients with bladder cancer and 2,259 patients with upper tract urothelial carcinoma, were included in this meta-analysis. Publication bias was addressed through Egger's test, and the heterogeneity among studies was assessed by the I(2) test statistic and subgroup analyses. RESULTS Current smokers at diagnosis are at increased risk for local recurrence in nonmuscle invasive bladder cancer (HR 1.27, 95% CI 1.09-1.46) and smokers with muscle invasive bladder cancer have an increased risk of dying of bladder cancer (HR 1.23, 95% CI 1.02-1.44). In the upper tract urothelial carcinoma population smokers have an increased risk of recurrence in the operative bed (HR 1.57, 95% CI 1.19-1.95) and of death from upper tract urothelial carcinoma (HR 1.53, 95% CI 1.13-1.92). We did not identify significant heterogeneity among included studies. CONCLUSIONS The body of evidence is limited due to the absence of prospective studies. However, the results from this meta-analysis unambiguously support the hypothesis that lifetime cigarette smokers are at increased risk for a more malignant type of urothelial carcinoma associated with a worse prognosis.
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Affiliation(s)
- Frits H M van Osch
- Department of Complex Genetics, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom.
| | - Sylvia H J Jochems
- Department of Complex Genetics, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Frederik J van Schooten
- Department of Pharmacology and Toxicology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Maurice P Zeegers
- Department of Complex Genetics, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
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17
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Rink M, Crivelli JJ, Shariat SF, Chun FK, Messing EM, Soloway MS. Smoking and Bladder Cancer: A Systematic Review of Risk and Outcomes. Eur Urol Focus 2015; 1:17-27. [DOI: 10.1016/j.euf.2014.11.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 11/03/2014] [Accepted: 11/27/2014] [Indexed: 12/22/2022]
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18
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Cumberbatch MG, Rota M, Catto JWF, La Vecchia C. The Role of Tobacco Smoke in Bladder and Kidney Carcinogenesis: A Comparison of Exposures and Meta-analysis of Incidence and Mortality Risks. Eur Urol 2015; 70:458-66. [PMID: 26149669 DOI: 10.1016/j.eururo.2015.06.042] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/22/2015] [Indexed: 01/11/2023]
Abstract
CONTEXT Tobacco smoke includes a mix of carcinogens implicated in the etiology of bladder cancer (BC) and renal cell cancer (RCC). OBJECTIVE We reviewed the impact of tobacco exposure on BCC and RCC incidence and mortality, and whether smoking cessation decreases the risk. EVIDENCE ACQUISITION A systematic review of original articles in English was performed in August 2013. Meta-analysis of risks was performed using adjusted risk ratios where available. Publication bias was assessed using Begg and Egger tests. EVIDENCE SYNTHESIS We identified 2683 papers, of which 107 fulfilled our inclusion criteria, of which 83 studies investigated BC and 24 investigated RCC. The pooled relative risk (RR) of BC incidence was 2.58 (95% confidence interval [CI] 2.37-2.80) for all smokers, 3.47 (3.07-3.91) for current smokers, and 2.04 (1.85-2.25) for former smokers. The corresponding pooled RR of BC disease-specific mortality (DSM) was 1.47 (1.24-1.75), 1.53 (1.12-2.09) and 1.44 (0.99-2.11). The pooled RR of RCC incidence was 1.31 (1.22-1.40) for all smokers, 1.36 (1.19-1.56) for current smokers, and 1.16 (1.08-1.25) for former smokers. The corresponding RCC DSM risk was 1.23 (1.08-1.40), 1.37 (1.19-1.59), and 1.02 (0.90-1.15). CONCLUSIONS We present an up-to-date review of tobacco smoking and BC and RCC incidence and mortality. Tobacco smoking significantly increases the risk of BC and RCC incidence. BC incidence and DSM risk are greatest in current smokers and lowest in former smokers, indicating that smoking cessation confers benefit. We found that secondhand smoke exposure is associated with a significant increase in BC risk. PATIENT SUMMARY Tobacco smoking affects the development and progression of bladder cancer and renal cell cancer. Smoking cessation reduces the risks of developing and dying from these common cancers. We quantify these risks using the most up-to-date results published in the literature.
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Affiliation(s)
- Marcus G Cumberbatch
- Academic Urology Unit, University of Sheffield, The Medical School, Beech Hill Road, Sheffield, UK.
| | - Matteo Rota
- Department of Epidemiology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, The Medical School, Beech Hill Road, Sheffield, UK
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Sosnowski R, Przewoźniak K. The role of the urologist in smoking cessation: why is it important? Urol Oncol 2014; 33:30-39. [PMID: 25154777 DOI: 10.1016/j.urolonc.2014.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/20/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Tobacco use is the most preventable cause of death in the world today. Smoking is a well-known risk factor for various cancers, including urothelial carcinoma, and bladder cancer (BCa) is a leading global cause of cancer mortality in men. OBJECTIVE To review the epidemiology of BCa as a tobacco-related disease, the association between smoking and BCa risk, and the potential smoking cessation interventions that urologists can perform in their medical practice. METHODS A search of recent literature was conducted using the MEDLINE database and the Internet, as well as resources from well-known health, cancer, and tobacco control organizations. RESULTS Smoking is well described as a risk factor of BCa. The risk correlates with the number of cigarettes smoked daily and the duration of smoking. Moreover, smoking worsens BCa treatment outcomes and prognosis. However, smoking cessation substantially prolongs life at every stage, and brief medical interventions can be performed by urologists that can result in the patient ceasing to smoke. Patient education is critical, especially if the patient is unaware that smoking increases the risk of BCa. CONCLUSION Urologists may play an essential role in helping their patients cease smoking, subsequently decreasing the smoking-related risk of BCa. Their cessation efforts should be focused on brief interventions and collaboration with specialized smoking cessation resources.
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Affiliation(s)
- Roman Sosnowski
- Department of Urooncology, the Maria Skłodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland.
| | - Krzysztof Przewoźniak
- Department of Cancer Epidemiology and Prevention, the Maria Skłodowska-Curie Cancer Center and Institute of Oncology, Warsaw, Poland
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20
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Pietzak EJ, Malkowicz SB. Does Quantification of Smoking History Correlate with Initial Bladder Tumor Grade and Stage? Curr Urol Rep 2014; 15:416. [DOI: 10.1007/s11934-014-0416-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Crivelli JJ, Xylinas E, Kluth LA, Rieken M, Rink M, Shariat SF. Effect of smoking on outcomes of urothelial carcinoma: a systematic review of the literature. Eur Urol 2013; 65:742-54. [PMID: 23810104 DOI: 10.1016/j.eururo.2013.06.010] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/07/2013] [Indexed: 01/23/2023]
Abstract
CONTEXT Cigarette smoking is the best-established risk factor for urothelial carcinoma (UC). However, the effect of smoking on outcomes of UC patients remains debated. OBJECTIVE To integrate the available evidence regarding the impact of smoking status and smoking exposure on recurrence, progression, cancer-specific mortality, and any-cause mortality in patients with UC of the bladder (UCB) and upper tract UC (UTUC) treated with transurethral resection of the bladder (TURB), radical cystectomy (RC), or radical nephroureterectomy (RNU). EVIDENCE ACQUISITION A systematic search of the literature was conducted using the Medline, Embase, and Scopus databases, which was limited to articles published in English between January 1974 and March 2013. Articles were also extracted from the reference lists of identified studies and reviews. We selected 29 articles (15 TURB, 7 RC, and 7 RNU) according to predefined inclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-analyses. EVIDENCE SYNTHESIS The majority of studies demonstrated an association with disease recurrence in patients treated with TURB, while evidence for associations with disease progression, cancer-specific mortality, and any-cause mortality was less abundant. While two studies showed no association of smoking with outcomes of T1 UCB, there was mixed evidence for an association of smoking with response to intravesical therapy. For patients treated with RC, there was minimal support for an association of smoking with all outcomes. In a majority of studies of patients receiving RNU for UTUC, smoking was associated with intravesical recurrence, disease recurrence, cancer-specific mortality, and any-cause mortality. There was also evidence for a beneficial effect of smoking cessation on UC prognosis. Finally, findings regarding gender-specific effects of smoking on prognosis were contradictory. We note that there was marked heterogeneity in patient populations and smoking categorizations across studies, precluding a meta-analysis. CONCLUSIONS Smoking may lead to less favorable outcomes for UCB and UTUC patients, and smoking cessation may mitigate this effect. The current evidence base lacks studies on the effects of smoking on prognosis in numerous clinical demographic subgroups of UC patients, as well as prospective investigation of smoking cessation.
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Affiliation(s)
- Joseph J Crivelli
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte Rieken
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria.
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