Association Between Smoking Exposure, Neoadjuvant Chemotherapy Response and Survival Outcomes Following Radical Cystectomy: Systematic Review and Meta-Analysis

Studies exploring the association of cigarette smoking with long-term survival outcomes following radical cystectomy (RC) have revealed debatable results. We performed a systematic review and meta-analysis to investigate the impact of tobacco smoking exposure, duration, intensity, and cessation on response to neoadjuvant chemotherapy (NACh) and long-term survival outcomes in patients undergoing RC for bladder cancer (BCa)Methods:A systematic search of original articles published up to April 2019 was performed using PubMed, MEDLINE, Embase, and Cochrane Library databases. The primary endpoints were NACh response, overall and cancer-specific mortality and recurrence free survival after RC. Observational studies reporting Cox proportional hazards regression or logistic regression analyses were independently screened. Available multivariable hazard ratios (HRs) and corresponding 95% CIs were included in quantitative analysis. Sensitivity analyses were performed as appropriate. A risk-of-bias assessment was completed for nonrandomized studies. (PROSPERO number CRD42019130703).