Impact of smoking status and cumulative exposure on intravesical recurrence of upper tract urothelial carcinoma after radical nephroureterectomy

OBJECTIVES: To assess the impact of cigarette smoking status, cumulative smoking exposure, and time from cessation on intravesical recurrence (IVR) outcomes in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).

PATIENTS AND METHODS: A total of 519 patients underwent RNU at five institutions. Smoking history included smoking status, quantity of cigarettes per day (CPD), duration, and time from cessation. The cumulative smoking exposure was categorized as light-short-term (≤19CPD and ≤19.9years), moderate (all combinations except light-short-term and heavy-long-term), and heavy-long-term (≥20CPD and ≥20years). Univariable/multivariable cox regression analyses assessed the effects of smoking on IVR.

RESULTS: A total of 190 patients (36%) never smoked; 205 (40%) and 125 (24%) were former and current smokers, respectively. Among smokers, 42 (8%), 185 (36%), and 102 (20%) patients were light-short-term, moderate, and heavy-long-term smokers, respectively. Within a median follow-up of 37 months, 152 patients (29%) experienced IVR. Actuarial IVR-free-survival estimates at 2, 5, and 10years were 72±2% (standard error), 58±3%, and 51±4%, respectively. In multivariable analyses, current smoking status, smoking intensity (≥20 CPD), smoking duration (≥20years), and heavy-long-term smoking were associated with higher risk of IVR (p values≤0.01). Patients who quit smoking≥10 years prior to RNU had better IVR outcomes than current smokers and those patients who quit smoking<10 yr prior to RNU.

CONCLUSION: Cigarette smoking is significantly associated with IVR in patients treated with RNU for UTUC. Current and heavy-long-term smokers have the highest risk of IVR. Smoking cessation >10 yr prior to RNU seems to mitigate these detrimental effects.