non-smokers, light-smokers ( 30 pack/years), and heavy-smokers ( 30 pack/years). Clinicopathologic characteristics of the initial presentation and initial bladder tumor were analyzed. Variables included gender, race, BMI, initial presenting symptom, tumor grade, clinical stage, lymph-vascular invasion (LVI), clinical CIS, packs per day (PPD), years of smoking, and years since smoking cessation. One-way ANOVA was used for continuous variables, and chi squared test for categorical variables. Logistic regression was used to calculate odds ratio (OR) for muscle invasive bladder cancer (MIBC) at initial presentation. RESULTS: Of the 740 patients available for analysis, 197 (26.6%) were non-smokers, 251 (33.9%) were light smokers, and 292 (39.5%) were heavy smokers. No difference was seen for race (p 0.29) and BMI (p 0.23); however males were more likely to be heavy smokers compared to females (44.5% v. 23.6% p 0.001). Compared to non-smokers and light smokers, the initial tumors in heavy smokers were more likely to be high grade (p 0.02), have a more advanced clinical stage (p 0.05), and to present with MIBC (p 0.04). No statistical difference was seen regarding LVI (p 0.63) and clinical CIS (p 0.2). Heavy smokers were also more likely to have gross hematuria as presenting symptom (p 0.06). When compared to non-smokers, the OR for presenting with MIBC was 1.18 (95%CI 0.682.1) for light smokers and 1.38 (95%CI 1.06-1.8) for heavy. When adjusting for gender, heavy smoking remained a risk for presenting with MIBC for males (p 0.02), but not for females (p 0.7). CONCLUSIONS: When compared to non-smokers and light smokers, patients with a 30 pack/years smoking history are more likely to have higher grade tumors, more advanced clinical stage, and an increased risk of muscle invasion at initial presentation. This effect appears to be greater in male heavy smokers compared to females.