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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.

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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

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