Smoking and smoking cessation effects on oncological outcomes in nonmuscle invasive bladder cancer

Cigarette smoking is the best established risk factor for the development of bladder cancer. Nevertheless, the impact of smoking and smoking cessation on the outcomes of patients with nonmuscle invasive bladder cancer (NMIBC) remains poorly investigated.

Currently, there are no prospective studies analyzing the impact of smoking on NMIBC outcomes. The majority of retrospective studies found an association between smoking status as well as cumulative lifetime exposure and disease recurrence. A recently published study demonstrated a significant impact of smoking on disease progression; however, the evidence regarding this end point is weak. There are insufficient data investigating the impact on cancer-specific and overall survival in patients with NMIBC. Assessment of the impact of smoking on particular subsets of patients with NMIBC including T1 or high-risk disease, patients receiving intravesical therapies, or sex-specific differences is limited because of a lack of data and controversial findings. Smoking cessation seems to mitigate the detrimental effects on outcomes.

Although there are limited data, the growing body of evidence indicates that smoking increases the risk of disease recurrence and potentially disease progression in patients with NMIBC. Current and heavy long-term smokers seem to be at the greatest risk for both end points. Smoking cessation may limit these effects thereby improving prognosis. To improve our understanding of the associations of this important, modifiable risk factor with outcomes in patients with NMIBC, smoking should be incorporated into clinical trial design and analysis. It is the duty of each urologist to raise awareness regarding the greatest preventable cause of the development of bladder cancer, morbidity, and mortality.