Patients treated for bladder cancer with a radical cystectomy have worse outcomes if they are smokers, according to a systematic review and meta-analysis by Keck Medicine of the University of Southern California (USC). The study appeared in The Journal of Urology.1
“This study is important because while it is known that tobacco smoking is the leading cause of bladder cancer, this is the first study to suggest that smoking puts bladder cancer patients at risk after diagnosis,” said Giovanni Cacciamani, MD, lead author of the study and Assistant Professor of Research Urology at USC.
Giovanni Cacciamani, MD
More than 500,000 cases of bladder cancer are diagnosed each year worldwide. When the cancer is large or has spread beyond the bladder, patients are typically treated with chemotherapy followed by a radical cystectomy.
Dr. Cacciamani and Keck Medicine researchers searched databases to select 17 studies that reported on the impact of tobacco smoking on chemotherapy response and survival outcomes of 13,777 patients following radical cystectomy. Of these patients, 40.8% were active smokers at the time of the surgery, 14.1% were former smokers, and 45.1% had never smoked or were not smoking at the time of the surgery.
The study showed that active smokers responded worse to chemotherapy and had higher mortality rates, both in general and specifically from bladder cancer, and a higher rate of bladder cancer recurrence than patients who never smoked or were not smoking at the time of surgery. Former smokers also fared worse in these categories than those who had never smoked, even though the differences were less significant.
One reason smoking affects outcomes is that nicotine has shown to suppress the body’s immune system, leading to more complications, according to the study authors. “In addition, patients with a history of smoking tend to have more aggressive forms of cancer and, if they survive bladder cancer, are more at risk for other potentially fatal cancers, such as lung cancer,” said Dr. Cacciamani.
Looking forward, the researchers recommend that health-care professionals advise bladder cancer patients to stop smoking after their diagnoses. “The research suggests that as long as a person is not smoking at the time of chemotherapy and surgery, they might do better,” noted Dr. Cacciamani. He also recommended that physicians monitor smokers more carefully postsurgery than other patients because they are more at risk for complications or death. In addition, the study authors recommend that future studies or clinical trials involving bladder cancer chart patients’ smoking status to create a more accurate picture of what factors affect cancer survival and recurrence.
DISCLOSURE: Dr. Cacciamani reported no conflicts of interest.
1. Cacciamani GE, Ghodoussipour S, Mari A, et al: Association between smoking exposure, neoadjuvant chemotherapy response and survival outcomes following radical cystectomy: Systematic review and meta-analysis. J Urol 204:649-660, 2020.