Smoking behavior and the risks of tumor recurrence and progression in patients with non-muscle-invasive bladder cancer

Sep 21, 2026

Studies examining cigarette smoking and the risks of recurrence and progression in non-muscle-invasive bladder cancer (NMIBC) have been inconsistent, with limited prospective evidence. This study assessed smoking behavior in the prospective multi-center UroLife cohort (1495 NMIBC patients) using smoking status, intensity, duration, pack years, and time since cessation, and applied multivariable proportional hazards models to recurrence and progression outcomes. Over a median follow-up of 4.6 years, higher smoking intensity and pack years were linked to higher first recurrence risk, especially in BCG-treated patients. Results were inconsistent for progression.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

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Abstract

Introduction

DOI: 10.1002/ijc.35250 RES EARCH A RTICLE Ca ncer Epidemiology Smoking behavior and the risks of tumor recurrence and progression in patients with non-muscle-invasive bladder cancer Joann Kiebach 1 | Ivy Beeren 1 | Katja K. H. Aben 1,2 | J. Alfred Witjes 3 | Antoine G. van der Heijden 3 | Lambertus A. L. M. Kiemeney 1,3 | Alina Vrieling 1 1IQ Health Science Department, Radboud University Medical Center, Nijmegen, The Netherlands 2Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands 3Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands Correspondence Alina Vrieling, Radboud University Medical Center, Kapittelweg 54, 6525 EP Nijmegen, The Netherlands. Email: [alina.vrieling@radboudumc.nl](alina.vrieling@radboudumc.nl) Funding information Wereld Kanker Onderzoek Fonds (WKOF), as part of the World Cancer Research Fund International grant programme, Grant/Award Number: IIG_2022_ 017; Dutch Cancer Society, Grant/Award Number: 2017-2/11179; Alpe d’ HuZes/Dutch Cancer Society, Grant/Award Number: KUN 2013-5926 Abstract Studies on the relationship of cigarette smoking with the risks of recurrence and progression of non-muscle-invasive bladder cancer (NMIBC) are inconsistent and prospective data are scarce. Therefore, we aimed to assess the association of smoking behavior with risks of NMIBC recurrence and progression. We used data of the prospective multi-center cohort study UroLife, including 1495 patients with NMIBC who reported information on smoking at 6 weeks post-diagnosis (baseline; reflecting present and pre-diagnosis) . This included smoking status (also based on reporting 3 months post-diagnosis), intensity, duration, pack years, and time since smoking cessation, if applicable. Hazard ratios and 95% confidence intervals (CIs) for risks of first recurrence, multiple recurrences, and progression were computed using multivariable proportional hazards regression models. During a total median follow-up period of 4. 6 years, 517 patients developed ≥1 recurrence and 163 had progression. Higher versus lowest categories of smoking intensities and pack years up to baseline were significantly associated with a higher risk of first recurrence. No significant linear associations were found, except for smoking intensity among BCG-treated patients (per 10 cigarettes/day increase: HR 1 .23, 95%CI 1 .02, 1 .48) . No associations for smoking status, duration, and time since cessation were observed. Analyses of multiple recurrence risk showed comparable results. Regarding progression risk, no consistent associations were found. In conclusion, heavier smoking was associated with higher recurrence risk, particularly among BCG-treated patients. This may be attributable to persistent damage through its carcinogenic compounds. Given the mixed results across different exposures, the effect of smoking behavior on NMIBC prognosis remains unclear. KEYWOR DS cancer survivors, non-muscle-invasive bladder cancer, progression, recurrence, smoking This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2024 The Author(s) . International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC. What's New? Patients with non-muscle-invasive bladder cancer (NMIBC) have a high risk of recurrence, and although smoking is considered the most important modifiable risk factor for bladder cancer, it isnot clear from the data how smoking affects the risk of recurrence and progression of NMIBC. Here, the authors analyzed data from the prospective, multi-center UroLife study, which collected data on a variety of factors related to smoking habits. Heavier smoking was associated with higher recurrence r

FAQs

What was the main goal of the UroLife study regarding smoking and NMIBC?

To evaluate how smoking behavior is associated with the risks of NMIBC recurrence and progression using prospective cohort data and time-based smoking information.

Which smoking measures were associated with higher recurrence risk?

Higher categories of smoking intensity and pack years up to baseline were significantly associated with a higher risk of first recurrence.

Did smoking affect progression risk consistently in this study?

No consistent associations were found for progression risk, although heavier smoking was linked to higher recurrence risk, particularly among BCG-treated patients.

Sep 21, 2026

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