Mp56-07 impact of smoking, cumulative exposure and cessation on oncologic outcomes after radical cystectomy and adjuvant chemotherapy for locally-advanced bladder cancer: a multicenter study

You have accessJournal of UrologyCME1 Apr 2023MP56-07 IMPACT OF SMOKING, CUMULATIVE EXPOSURE AND CESSATION ON ONCOLOGIC OUTCOMES AFTER RADICAL CYSTECTOMY AND ADJUVANT CHEMOTHERAPY FOR LOCALLY-ADVANCED BLADDER CANCER: A MULTICENTER STUDY Frederik König, Nico C. Grossmann, Benjamin Pradere, David D'Andrea, Fahad Quhal, Pawel Rajwa, Ekaterina Laukhtina, Keiichiro Mori, Satoshi Katayama, Takafumi Yanagisawa, Tatsushi Kawada, Maximilian Pallauf, Abdulmajeed Aydh, Reza Sari Motlagh, Malte W. Vetterlein, Philipp Gild, Roland Dahlem, Michael Rink, Margit Fisch, Pierre I. Karakiewicz, and Sharokh F. Shariat Frederik KönigFrederik König More articles by this author , Nico C. GrossmannNico C. Grossmann More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , David D'AndreaDavid D'Andrea More articles by this author , Fahad QuhalFahad Quhal More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Takafumi YanagisawaTakafumi Yanagisawa More articles by this author , Tatsushi KawadaTatsushi Kawada More articles by this author , Maximilian PallaufMaximilian Pallauf More articles by this author , Abdulmajeed AydhAbdulmajeed Aydh More articles by this author , Reza Sari MotlaghReza Sari Motlagh More articles by this author , Malte W. VetterleinMalte W. Vetterlein More articles by this author , Philipp GildPhilipp Gild More articles by this author , Roland DahlemRoland Dahlem More articles by this author , Michael RinkMichael Rink More articles by this author , Margit FischMargit Fisch More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , and Sharokh F. ShariatSharokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Next to bladder carcinogenesis, smoking is also highly associated with more aggressive disease. Moreover, it can deteriorate pharmacokinetics and reduces response to neoadjuvant chemotherapy upfront radical cystectomy (RC). Knowledge of its impact on the efficacy of chemotherapy in the adjuvant setting is, however, still limited. This was the first study to investigate the effects of smoking habits on oncologic outcomes after RC and adjuvant chemotherapy (AC) for locally-advanced bladder cancer (BC). METHODS: This multicenter study included patients from Europe and the US treated with RC and AC between 1995 and 2018. Clinicopathological factors, chemo regimes and smoking data including cumulative exposure (quantity+duration) and time since cessation were collected. Ever smokers were categorized into groups according to their lifetime cumulative exposure. Kaplan-Meier curves and log-rank tests were used to compare survival outcomes; uni- and multivariable Cox regression analyses to assess the association of smoking with recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). RESULTS: 448 patients were included. Among them, 96(21%) were never, 204(46%) former and 147(33%) current smokers. AC with Cisplatin-based regimes (Cis mono, Cis/Gem, MVAC) were used in over 90% of cases; 10% received Carbo/Gem or others. There were no differences in clinicopath. Characteristics across the groups. Current smokers were at a significantly higher risk of disease recurrence compared to never smokers (p=0.02). However, never, former and current smokers had comparable 3 year-estimates of OS, CSS and RFS. The cumulative smoking exposure was associated with all oncological endpoints (all p<0.04) and long-term smokers (>20 years), both light and heavy, had the worst outcomes (all p<0.03). On uni- and multivariable regression analyses, long-term smoking was a predictor for worse OS, CSS and RFS; smoking cessation for >10years was associated with lower risks for disease recurrence and cancer-specific death (p<0.042). CONCLUSIONS: Smoking may reduce the efficacy of chemotherapy for BC and is an independent predictor for disease recurrence after RC and AC. Duration, rather than intensity, seems to be a key determinant of oncologic outcomes. Smoking cessation for >10 years may mitigate the risks for disease recurrence and cancer-specific mortality. Smoking cessation should be integrated into urologic counselling regardless of the disease state. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e776 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Frederik König More articles by this author Nico C. Grossmann More articles by this author Benjamin Pradere More articles by this author David D'Andrea More articles by this author Fahad Quhal More articles by this author Pawel Rajwa More articles by this author Ekaterina Laukhtina More articles by this author Keiichiro Mori More articles by this author Satoshi Katayama More articles by this author Takafumi Yanagisawa More articles by this author Tatsushi Kawada More articles by this author Maximilian Pallauf More articles by this author Abdulmajeed Aydh More articles by this author Reza Sari Motlagh More articles by this author Malte W. Vetterlein More articles by this author Philipp Gild More articles by this author Roland Dahlem More articles by this author Michael Rink More articles by this author Margit Fisch More articles by this author Pierre I. Karakiewicz More articles by this author Sharokh F. Shariat More articles by this author Expand All Advertisement PDF downloadLoading ...