Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Jun;149(6):2673-2691.
doi: 10.1007/s00432-022-04464-6. Epub 2022 Nov 21.

The impact of smoking on recurrence and progression of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Aleksander Ślusarczyk  1 , Piotr Zapała  2 , Łukasz Zapała  3 , Piotr Radziszewski  3
Affiliations
Meta-Analysis

The impact of smoking on recurrence and progression of non-muscle invasive bladder cancer: a systematic review and meta-analysis

Aleksander Ślusarczyk et al. J Cancer Res Clin Oncol. 2023 Jun.

Abstract

Objectives: Although smoking is a well-recognized causative factor of urothelial bladder cancer and accounts for 50% of cases, less is known about the prognostic significance of smoking on non-muscle invasive bladder cancer (NMIBC) prognosis. This systematic review and meta-analysis aimed to evaluate the effect of smoking on the risk of NMIBC recurrence and progression.

Materials and methods: We systematically searched Medline, Web of Science and Scopus databases for original articles published before October 2021 regarding the effect of smoking on NMIBC recurrence and progression. Information about smoking status and the number of events or odds ratio or hazard ratio for event-free survival must have been reported to include the study in the analysis. Quality In Prognosis Studies tool was utilized for the risk of bias assessment.

Results: We selected 64 eligible studies, including 28 617 patients with NMIBC with available data on smoking status. In a meta-analysis of 28 studies with 7885 patients, we found that smokers (current/former) were at higher risk for recurrence (OR = 1.68; 95% CI 1.34-2.09; P < 0.0001) compared to never smokers. Subgroup analysis of 2967 patients revealed that current smokers were at a 1.24 higher risk of recurrence (OR = 1.24; 95% CI 1.02-1.50; P = 0.03) compared to former smokers. A meta-analysis of the hazard ratio revealed that smokers are at higher risk of recurrence (HR = 1.31; 95%CI 1.15-1.48; P < 0.0001) and progression (HR = 1.18; 95%CI 1.08-1.29; P < 0.001) compared to never smokers. Detrimental prognostic effect of smoking on progression, but not for recurrence risk was also noted in the subgroup analysis of high-risk patients (HR = 1.30; 95%CI 1.09-1.55; P = 0.004) and BCG-treated ones (HR = 1.15; 95%CI 1.06-1.25; P < 0.001).

Conclusion: In conclusion, patients with non-muscle invasive bladder cancer and a history of smoking have a worse prognosis regarding recurrence-free and progression-free survival compared to non-smokers.

Keywords: Current smoker; Non-muscle-invasive bladder cancer; Progression; Recurrence; Smoking.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart for study selection process using Medline, Web of Science and Scopus databases to identify the original articles demonstrating the effect of smoking on prognosis in non-muscle-invasive bladder cancer
Fig. 2
Fig. 2
Risk of bias assessment using Quality In Prognosis Studies tool (QUIPS)
Fig. 3
Fig. 3
The association of smoking with recurrence risk (A) and progression risk (B) in patients with non-muscle invasive bladder cancer
Fig. 4
Fig. 4
Recurrence risk in current compared to former smokers (A) and in former compared to never smokers (B) with non-muscle invasive bladder cancer
Fig. 5
Fig. 5
The association of smoking with recurrence-free survival in patients with non-muscle invasive bladder cancer
Fig. 6
Fig. 6
Recurrence-free survival in current compared to never smokers (A) and in former compared to never smokers (B) with non-muscle invasive bladder cancer
Fig. 7
Fig. 7
The association of smoking with progression-free survival in patients with non-muscle invasive bladder cancer
Fig. 8
Fig. 8
The association of smoking with recurrence-free survival (A) and progression-free survival (B) in high-risk non-muscle invasive bladder cancer
Fig. 9
Fig. 9
The association of smoking with recurrence-free survival (A) and progression-free survival (B) in BCG-treated patients with non-muscle invasive bladder cancer
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Abd Elwahab KM, Desky EAE, Eldery MS, Mohammad FF, Seleem MM, El-Babouly IM (2021) Apparent diffusion coefficient value can predict poor bacillus calmette-guérin responders in T1HG/NMIBC: prospective cohort study. Clin Genitourin Cancer 19(4):e248–e254 - PubMed
    1. Abufaraj M, Shariat SF, Haitel A, Moschini M, Foerster B, Chłosta P et al (2017) Prognostic role of N-cadherin expression in patients with non–muscle-invasive bladder cancer. Urol Oncol Semin Orig Investig 35(5):264–271 - PubMed
    1. Adamkiewicz M, Bryniarski P, Kowalik M, Burzyński B, Rajwa P, Paradysz A (2021) Lymphocyte-to-monocyte ratio is the independent prognostic marker of progression in patients undergoing BCG-immunotherapy for bladder cancer. Front Oncol 26(11):655000 - PMC - PubMed
    1. Ahirwar D, Kesarwani P, Manchanda PK, Mandhani A, Mittal RD (2008) Anti- and proinflammatory cytokine gene polymorphism and genetic predisposition: association with smoking, tumor stage and grade, and bacillus Calmette-Guérin immunotherapy in bladder cancer. Cancer Genet Cytogenet 184(1):1–8 - PubMed
    1. Ajili F, Manai M, Darouiche A, Chebil M, Boubaker S (2012) Tumor multiplicity is an independent prognostic factor of non-muscle-invasive bladder cancer treated with bacillus calmette-guerin immunotherapy. Ultrastruct Pathol 36(5):320–324 - PubMed

MeSH terms

LinkOut - more resources