Influence of smoking status on the disease-related outcomes of patients with tobacco-associated superficial transitional cell carcinoma of the bladder

BACKGROUND. The aim of this study was to assess the influence of tobacco ex posure, at the time of diagnosis, on the disease-related outcomes of patien ts with tobacco-associated superficial transitional cell carcinoma (TCC) of the bladder. METHODS. A retrospective cohort study was performed using the MSKCC Registr y to identify all institutional cases of "noninvasive" TCC (n = 1632) betwe en 1985 and 1995. After employing exclusion criteria, 286 cases of incident tobacco-associated superficial TCC were divided into 3 strata of tobacco e xposure (127 ex-smokers, 51 quitters, and 108 continued smokers) by chart r eview and post hoc questionnaires (n = 82). Measured outcomes included recu rrence 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-Guerin 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 a t time of diagnosis, and reliability was excellent (kappa = 0.89). Multivar iate analyses revealed diminished recurrence free survival among continued smokers versus quitters or ex-smokers. Univariate analyses revealed diminis hed adverse event free survival among continued smokers versus quitters or ex-smokers. Multivariate models assessing adverse event free survival revea led a similar trend (P = 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. [See e ditorial on pages 2192-4, this issue]. (C) 1999 American Cancer Society.