Presentation Authors: Luca Boeri*, Vidit Sharma, Matteo Soligo, Igor Frank, Stephen A. Boorjian, R. Houston Thompson, Matthew Tollefson, Fernando J. Quevedo, John C. Cheville, R. Jeffrey Karnes, Rochester, MN
Introduction: Smoking may be implicated in mechanism of resistance to cisplatin-based chemotherapy in bladder cancer and other solid malignancies. However, evidence suggesting a nicotine-induced resistance to cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) is scarce. We aimed to investigate the association between smoking status and pathological response to cisplatin-based NAC and survival outcomes in patients with MIBC treated with radical cystectomy (RC).
Methods: We reviewed 201 patients treated with NAC and RC for cT2-cT4N0M0 BC between 01/1999 and 01/2015. Smoking status was categorized as never smoker, former and current smoker. Pathological response to NAC was defined as: complete (ypT0N0), partial (ypTis/Ta/T1,N0) and no response (ypT2-4 or ypN+). Clinicopathologic characteristics were analysed according to smoking status. Logistic regression analyses tested the association between smoking status and pathologic response to NAC. Cox regression analyses tested risk factors associated with recurrence, overall (OM) and cancer specific mortality (CSM).
Results: Overall, there were 58 (28.9%) never smokers, 87 (43.3%) former smokers and 56 (27.9%) current smokers. Current smokers had higher rate of clinical extravesical disease (p=0.017) and preoperative hydronephrosis (p=0.01). No response to NAC was more frequently noted in current smokers (73.2%; p=0.007). Former smoker (OR 2.28; p=0.024) and current smoker status (OR 4.52; p < 0.001) were significantly associated with no response to NAC, after adjusting for age, gender, CCI and clinical stage. Current smoking status (HR 2.14; p=0.03) and extravesical pathologic tumor stage (HR 3.31; p < 0.001) were independently associated with an increased risk of recurrence after RC. Univariable analysis showed that current smoker status was significantly associated with OM (OR 1.82; p=0.043) and CSM (OR 1.89; p=0.048). However, at multivariable analysis, no statistically significant association was found between smoking status and OM or CSM.
Conclusions: Cigarette smoking was significantly associated with adverse pathologic response to cisplatin-based NAC in MIBC patient treated with RC. Current smokers were at significantly higher risk of experiencing disease recurrence as compared to former and never smokers.