Cumulative smoking exposure correlates with progression in high-grade T1 bladder cancer

To evaluate the relationship between cumulative smoking exposure, measured in pack-years, and pathologic progression in patients with transitional cell carcinoma (TCC) of the bladder staged as high-grade T1 (HG-T1).

We conducted a retrospective cohort study of patients diagnosed with HG-T1 urothelial carcinoma between 2020 and 2024. Clinical and pathological data were extracted, including age, gender, BMI, comorbidities, tumor size/location, completeness of resection, and presence of variant histology. Pathologic progression was defined based on worsening histology or stage on follow-up restaging transurethral resection of bladder tumor (TURBT). A pearson correlation and multivariate logistic regression were used to assess associations.

Among the 80 patients analyzed, increasing cumulative smoking exposure, measured in pack-years, demonstrated a weak negative correlation with favorable pathology outcomes (r = -0.13). Neither tumor size nor completeness of resection showed a significant association with pathology change. Pathologic worsening was observed in 29.0% of smokers compared to 5.6% of non-smokers, with this difference approaching statistical significance (p = 0.057; OR = 7.0). When comparing non-smokers specifically to heavy smokers (⩾30 pack-years), the difference was statistically significant, with 34.4% of heavy smokers experiencing pathologic progression versus 5.6% of non-smokers (p = 0.036; OR = 8.9), indicating a strong association between heavy smoking exposure and adverse pathology.

Cumulative smoking exposure is an independent predictor of pathologic progression in patients with HG-T1 bladder cancer. These findings support the incorporation of smoking history into risk stratification models and underscore the importance of smoking cessation counseling in this population.