Impact of smoking on outcomes after intravesical bacillus Calmette–Guérin therapy for urothelial carcinoma not invading muscle of the bladder

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Abstract
Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The main goal of a prostate biopsy is to identify clinically relevant prostate cancer with the lowest possible morbidity from the procedure. Through time many have tried different variations in the procedure in an attempt to find the optimal methodology for performing prostate biopsies. These changes include better equipment in helping optimize cancer localizing, varying the number of cores in efforts to improve cancer detection and sampling various areas of the prostate to find cancer that may be hiding. To our knowledge we are the first to describe performing prostate biopsies with keeping the sampling size constant and varying the number of cores based on the size of the prostate. The study adds a variation in the current techniques used for prostate biopsies. In certain situations using a standard number of cores makes obtaining proper sampling of a prostate difficult. We propose a methodology in performing prostate biopsies that will allow for standardization of the tissue per core analyzed thus allowing for an improved sampling of the prostate. OBJECTIVE: To determine the influence of smoking on the outcomes of patient with urothelial carcinoma of the bladder (UCB) not invading muscle treated with BCG therapy. MATERIALS AND METHODS: A retrospective chart review was conducted on 623 consecutive patients treated with BCG therapy for high‐grade Ta ( n = 219; 35.2%), T1 ( n = 215; 34.5%) and/or carcinoma in situ ( n = 189; 30.3%). Cigarette smoking status was categorized as (smokers vs non‐smokers) and as (current smokers vs past smokers vs never smokers). In addition, we analyzed the time since smoking cessation as a continuous and categorical variable (smoking cessation after diagnosis vs 0.1–10 years before diagnosis vs more than 10 years before diagnosis). Association with outcomes was examined by univariate and multivariable analyses, adjusting for the effects of age, gender, stage and grade. RESULTS: The study cohort consisted of 423 males (67.9%) and 200 females (32.1%). Overall, 386 patients (62.0%) were past smokers, 97 (15.6%) were current smokers and 140 (22.5%) had never smoked. In both univariate and multivariable analyses, smoking status by any definition was not associated with the response to BCG therapy, disease recurrence, progression, all‐cause mortality or UCB‐specific mortality. TUR grade was significantly associated with disease progression. TUR stage and BCG response at 6 months were significantly associated with disease recurrence, progression, all‐cause mortality and UCB‐specific mortality. CONCLUSIONS: Smoking does not appear to affect the response to BCG therapy or long‐term oncological outcomes.

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