Impact of smoking status on bladder tumor recurrence after radical nephroureterectomy for upper tract urothelial carcinoma

Purpose: Although smoking status has a significant association with clinical features in patients with bladder cancer, there are few reports of the impact of smoking on the clinical outcome of upper tract urothelial cancer. We investigated the possible influence of smoking status on bladder tumor recurrence after radical nephroureterectomy. Materials and Methods: We identified a study population of 245 consecutive patients treated surgically for upper tract urothelial cancer at our 3 institutions between 1994 and 2010. We analyzed associations between subsequent bladder tumor recurrence and patient clinicopathological parameters, including smoking status. Results: The 3-year bladder tumor recurrence-free survival rate was 32.6% in current smokers, 37.6% in former smokers and 61.7% in nonsmokers. Multivariate analysis revealed that male gender (HR 1.90, 95% CI 1.15-3.16, p = 0.013) and smoking status (former vs none HR 1.77, 95% CI 1.07-2.93, p = 0.027 and current vs none HR 1.58, 95% CI 1.03-2.42, p = 0.035) were independent risk factors for subsequent bladder tumor recurrence. Also, of patients with a positive smoking history those with 50 pack-years or greater showed a significantly higher incidence of bladder tumor recurrence after radical nephroureterectomy (HR 2.00, p = 0.003). Conclusions: Positive smoking history and male gender were independent risk factors for bladder tumor recurrence after radical nephroureterectomy. A larger number of cigarettes smoked may increase the incidence of bladder tumor recurrence in patients with upper tract urothelial cancer.