Kim Philip H, Kent Matthew, Zhao Philip, Sfakianos John P, Bajorin Dean F, Bochner Bernard H, Dalbagni Guido
Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA,
World J Urol. 2014 Apr;32(2):453-9. doi: 10.1007/s00345-013-1128-x. Epub 2013 Jul 11.
Smoking is the primary etiologic risk factor for bladder cancer and has been implicated in mechanisms of chemoresistance. We investigated smoking as a potential predictor for pathologic outcomes after neoadjuvant chemotherapy (NC) and radical cystectomy (RC) for muscle-invasive bladder cancer.
We identified 139 patients treated with neoadjuvant cisplatin-based chemotherapy followed by RC for T2-4aN0M0 bladder cancer. Logistic regression was used to evaluate associations between smoking characteristics and pathologic outcomes (pT0, complete response; pT0/pTis/pT1, any response). In a secondary analysis, multivariate Cox regression was used to assess associations between smoking and recurrence-free and cancer-specific survival.
Our cohort consisted of 99 (71 %) males, with a median age of 65 (interquartile range 56, 71). Prevalence of never, former, and current smokers was 25, 45, and 29 %, respectively. In total, 63 patients experienced disease recurrence, 39 died of disease, and 11 died of other causes. There were no statistically significant associations between smoking characteristics and complete (p = 0.5) or any (p = 0.2) pathologic response to NC. Similarly, we did not find any association between smoking characteristics and recurrence (p = 0.6) or cancer-specific survival (p = 0.9).
In this series, smoking characteristics were not found to be predictive of pathologic response after NC and RC, although this analysis was limited by the small study sample size. However, the harmful effects of smoking warrants continued emphasis on smoking cessation counseling in bladder cancer patients.
吸烟是膀胱癌的主要病因风险因素，并与化疗耐药机制有关。我们研究了吸烟作为肌层浸润性膀胱癌新辅助化疗（NC）和根治性膀胱切除术（RC）后病理结果的潜在预测指标。
我们确定了139例接受以顺铂为基础的新辅助化疗后行RC治疗的T2-4aN0M0膀胱癌患者。采用逻辑回归评估吸烟特征与病理结果（pT0，完全缓解；pT0/pTis/pT1，任何缓解）之间的关联。在二次分析中，采用多变量Cox回归评估吸烟与无复发生存率和癌症特异性生存率之间的关联。
我们的队列包括99名（71%）男性，中位年龄为65岁（四分位间距56，71）。从不吸烟、曾经吸烟和当前吸烟者的比例分别为25%、45%和29%。共有63例患者出现疾病复发，39例死于疾病，11例死于其他原因。吸烟特征与NC的完全（p = 0.5）或任何（p = 0.2）病理反应之间无统计学显著关联。同样，我们未发现吸烟特征与复发（p = 0.6）或癌症特异性生存（p = 0.9）之间存在任何关联。
在本系列研究中，未发现吸烟特征可预测NC和RC后的病理反应，尽管该分析受到研究样本量小的限制。然而，吸烟的有害影响值得继续强调对膀胱癌患者进行戒烟咨询。
