Smoking Associated with Worse Outcomes for Patients with Bladder Cancer After Radial Cystectomy

According to researchers, these findings suggest “that as long as a person is not smoking at the time of chemotherapy and surgery, they might do better.”

An article published in The Journal of Urology suggested that in patients with bladder cancer, smoking status is associated with lower neoadjuvant chemotherapy response rates and higher overall and cancer specific mortality, as well as bladder cancer recurrence after radial cystectomy.1

Given these findings, researchers indicated that preoperative counseling, coupled with tightened follow-up, may have a pivotal role in improving the smoking-related long-term survival outcomes in patients with bladder cancer.

“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,” lead author Giovanni Cacciamani, MD, assistant professor of research urology at the Keck School of Medicine of USC, said in a press release.2

In this study, researchers systematically searched PubMed, MEDLINE, Embase, and Cochrane Library databases for original articles published before April 2019. Overall, 649 articles were identified, and 17 studies were selected that addressed the impact of smoking status on survival outcomes in 13,777 patients after radical cystectomy for bladder cancer.

The primary end points for the study were neoadjuvant chemotherapy response, overall and cancer specific mortality, and recurrence-free survival after radical cystectomy.

A pooled meta-analysis found that active smokers have an increased risk of overall mortality (HR, 1.21; 95% CI, 1.08-1.36; P = .001; I2 = 0%), cancer specific mortality (HR, 1.24; 95% CI 1.13-1.36; P < .00001; I2 = 0%), and bladder cancer recurrence (HR, 1.24; 95% CI, 1.12-1.38; P < .0001; I2 = 3%). Further, sensitivity analyses assessing only patients who underwent neoadjuvant chemotherapy followed by radical cystectomy revealed an advantage of non/never smokers in terms of neoadjuvant chemotherapy complete response rate (HR, 0.47; 95% CI 0.29-0.75; P = .001; I2 = 0%).

“The research suggests that as long as a person is not smoking at the time of chemotherapy and surgery, they might do better,” Cacciamani explained.

Moving forward, the investigators recommended that health care providers advise patients with bladder cancer to stop smoking following their diagnoses. In addition, it was suggested that future studies or clinical trials involving bladder cancer chart patients’ smoking status to develop a more precise idea of what factors affect cancer survival and recurrence.

“While this study does not answer all the questions, it is an excellent starting point for investigating the association between smoking and long-term oncological outcomes and will hopefully lead to new protocols that will benefit patients,” Cacciamani concluded.

Notably, a multicenter, randomized, controlled trial titled STOP-OP (Intensive Smoking and Alcohol Cessation Intervention in Bladder Cancer Surgery Patients; NCT02188446), is currently ongoing. Researchers noted that outcomes from this study will be evaluated following intensive smoking and alcohol cessation interventions performed shortly before and 5 weeks after bladder cancer surgery. Preliminary and long-term results of this study have yet to be released.


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. The Journal of Urology. doi: 10.1097/JU.0000000000000813

2. Cigarette smoking associated with worse outcomes for bladder cancer patients after surgery [news release]. Los Angeles. Published September 14, 2020. Accessed September 17, 2020.