Heavy Cigarette Smoking and Aggressive Bladder Cancer at Initial Presentation.

OBJECTIVE: To identify the impact of smoking intensity on tumor characteristics at the time of initial bladder cancer diagnosis. METHODS: We retrospectively reviewed our institution's prospective database of patients diagnosed with bladder cancer from 1987 to 2009. Only patients with urothelial cell carcinoma and recorded tobacco history were included. Patients were stratified by tobacco history into nonsmokers, light smokers (≤ 30 pack-years), and heavy smokers (> 30 pack-years). An additional analysis was performed looking at patients meeting National Lung Cancer Screening Trial (NLCST) criteria (55- to 74-year-old patients with ≥ 30 pack-years smoking history and < 15 years since smoking cessation). Clinicopathologic characteristics of the initial bladder tumor at time of diagnosis were analyzed. RESULTS: We identified 197 (26.6%) nonsmokers, 251 (33.9%) light smokers, and 292 (39.5%) heavy smokers. Males were more likely to be heavy smokers (44.5% vs 23.6%, P ≤ .01). Compared with nonsmokers and light smokers, the initial tumors in heavy smokers were more likely to be high grade with a more advanced clinical stage. Heavy smokers were more likely to present with muscle-invasive bladder cancer (MIBC) at initial diagnosis. When compared to nonsmokers, the odds ratio for presenting with MIBC was 1.18 (95% confidence interval = 0.68-2.1) for light smokers and 1.38 (95% confidence interval = 1.06-1.8) for heavy smokers. Of 793 patients with adequate information for analysis, 184 (23.2%) met NLCST criteria. Those meeting NLCST criteria were most likely to be male, to present with gross hematuria, and to have initial tumors that were high grade and muscle invasive. NLCST criteria eligibility remained associated with MIBC on multivariate analysis. CONCLUSION: Heavy smokers and patients meeting NLCST criteria are more likely to have high-grade tumors with detrusor muscle invasion at initial presentation.