Patients treated for bladder cancer with a surgery known as radical cystectomy have worse outcomes if they are smokers, according to a systematic review and meta-analysis by Keck Medicine of USC. The study appeared in the Journal of Urology.
“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,” Giovanni Cacciamani, lead author of the study and assistant professor of research urology at the Keck School of Medicine of USC, said in a statement.
More than 500,000 cases of bladder cancer are diagnosed each year worldwide. When the cancer is large or has spread beyond the bladder, patients are typically treated with chemotherapy followed by a radical cystectomy.
Cacciamani and fellow Keck Medicine researchers searched databases to select 17 studies that reported on the impact of tobacco smoking on chemotherapy response and survival outcomes of 13,777 patients following radical cystectomy. Of these patients, 40.8% were active smokers at the time of the surgery, 14.1% former smokers and 45.1% had never smoked or were not smoking at the time of the surgery.
The study showed that active smokers responded worse to chemotherapy and had higher mortality rates, both in general and specifically from bladder cancer, and a higher rate of bladder cancer recurrence than patients who never smoked or were not smoking at the time of surgery.
Former smokers also fared worse in these categories than those who had never smoked, even though the differences were less significant.
“The research suggests that as long as a person is not smoking at the time of chemotherapy and surgery, they might do better,” Cacciamani said in a statement.
He also recommends that physicians monitor smokers more carefully post-surgery than other patients because they are more at risk for complications or death.
In addition, the study authors recommend that future studies or clinical trials involving bladder cancer chart patients’ smoking status to create a more accurate picture of what factors affect cancer survival and recurrence.
Other Keck Medicine physicians who authored the study include Mihir Desai, Parkash Gill, Inderbir Gill, and Hooman Djaladat. Saum Ghodoussipour who is a former surgical oncology fellow with Keck Medicine, co-authored the study.
Researchers from medical institutions in Austria, Italy and Russia also participated in the study.
