AUA 2017: Smoking Intensity as a Predictor of Survival in Bladder Cancer Patients: Results from a Population-Based Florida Cancer Registry (1981-2009)

Boston, MA ( Luis Felipe Savio, University of Miami, assessed survival of bladder cancer patients according to smoking intensity using a large cancer registry database. Smoking is a well-known risk factor for bladder cancer and associated with inferior survival outcomes following treatment, however, the dose-response effect is less well understood.

Using the Florida Cancer registry from 1981-2009 a total of 68,001 patients diagnosed with urothelial carcinoma were identified. Of these, 12,793 patients had individual level smoking intensity records. Smoking intensity was assessed according to packs per day.

The majority of patients were male (74%), white (96%), non-Hispanic (91%) and presented with locally advanced disease (77%). After controlling for patient demographics and pathology including socioeconomic status and tumor stage, increased smoking to 1 or more packs per day more than doubles the risk of mortality than patients who are never smokers. When smoking status assessed according to gender, female patients had improved survival when compared to male patients (HR 0.87: 95% CI 0.84-0.90, p<0.001), respectively.

The findings must interpreted in the context of the study design. First, the authors mention the smoking status was assessed at the individual level, however, most cancer registries link cancer registry data with census level smoking status. One questions the accuracy of this individual level assessment of smoking status using this registry. Moreover, the lack of number of years smoked is an inherent limitation. Second, lack of more robust clinical and pathologic information limits which patients may be at greatest risk for mortality. Third, the study lacks controlling for potential confounders including occupation, treatments rendered, smoking cessation and follow-up.

In summary, this study provides further evidence to suggest increased smoking intensity leads to worse survival outcomes. Our institution is currently merging databases in order to assess for this and other poor prognostic indicators for survival among cancer patients including those who underwent radical cystectomy for bladder cancer.

Presented By: Luis Felipe Savio, University of Miami

Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA