Li Hao Min, Azhati Baihetiya, Rexiati Mulati, Wang Wen Guang, Li Xiao Dong, Liu Qiang, Wang Yu-Jie
Department of Urology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Medical University, Xinjiang, 830054, People's Republic of China.
Int Urol Nephrol. 2017 Jan;49(1):69-76. doi: 10.1007/s11255-016-1441-6. Epub 2016 Oct 20.
To investigate the effect of smoking status, cumulative smoking exposure and smoking cessation on the outcomes of patient with non-muscle-invasive bladder cancer (NMIBC).
We collected smoking data from 484 patients with NMIBC who were treated with transurethral resection (TUR); smoking status was categorized as (never smokers vs current smokers vs former smokers). Cumulative smoking exposure was categorized as high smoking exposure (cigarette index ≥400) versus low smoking exposure (cigarette index <400). Association with outcomes was examined by multivariable analyses after adjusting for the effects of standard clinicopathologic factors, and the Kaplan-Meier method was used to estimate the effect of smoking status and cumulative smoking exposure on RFS.
A total of 168 (34.7 %) patients were never smoker, 121 (25 %) patients were current smokers, and 195 (40.3 %) patients were former smokers. The median follow-up was 25 months. By multivariate analysis, pathological grade (p = 0.013), history of recurrence (p < 0.001), number of tumors (p < 0.001) and size of tumors (p = 0.013) were significantly associated with tumor recurrence; nevertheless, smoking status did not influence tumor recurrence (p = 0.063). Among current and former smokers, cumulative smoking exposure was significantly associated with tumor recurrence (p < 0.001), compared to current smokers, patients with smoking cessation ≥10 years had a lower risk of tumor recurrence [hazard ratio (HR) 0.456, p = 0.007].
Smoking affects the prognosis of patient with NMIBC, which is still controversial; however, among ever smokers, a high cumulative exposure smoking can significantly increase the risk of tumor recurrence. Quitting smoking might be associated with a lower recurrence rate for patients with NMIBC.
探讨吸烟状况、累积吸烟暴露量及戒烟对非肌层浸润性膀胱癌（NMIBC）患者预后的影响。
我们收集了484例接受经尿道切除术（TUR）治疗的NMIBC患者的吸烟数据；吸烟状况分为（从不吸烟者、当前吸烟者、既往吸烟者）。累积吸烟暴露量分为高吸烟暴露（香烟指数≥400）和低吸烟暴露（香烟指数<400）。在调整标准临床病理因素的影响后，通过多变量分析检验与预后的相关性，并采用Kaplan-Meier法评估吸烟状况和累积吸烟暴露量对无复发生存期（RFS）的影响。
共有168例（34.7%）患者从不吸烟，121例（25%）患者为当前吸烟者，195例（40.3%）患者为既往吸烟者。中位随访时间为25个月。多变量分析显示，病理分级（p = 0.013）、复发史（p < 0.001）、肿瘤数量（p < 0.001）和肿瘤大小（p = 0.013）与肿瘤复发显著相关；然而，吸烟状况并未影响肿瘤复发（p = 0.063）。在当前吸烟者和既往吸烟者中，累积吸烟暴露量与肿瘤复发显著相关（p < 0.001），与当前吸烟者相比，戒烟≥10年的患者肿瘤复发风险较低[风险比（HR）0.456，p = 0.007]。
吸烟对NMIBC患者预后的影响仍存在争议；然而，在曾经吸烟者中，高累积吸烟暴露量可显著增加肿瘤复发风险。戒烟可能与NMIBC患者较低的复发率相关。
