吸烟与顺铂为基础的新辅助化疗和根治性膀胱切除术治疗肌层浸润性膀胱癌患者的不良病理反应和疾病复发增加相关：单中心经验。
Cigarette smoking is associated with adverse pathological response and increased disease recurrence amongst patients with muscle-invasive bladder cancer treated with cisplatin-based neoadjuvant chemotherapy and radical cystectomy: a single-centre experience.
机构信息
Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
出版信息
BJU Int. 2019 Jun;123(6):1011-1019. doi: 10.1111/bju.14612. Epub 2019 Jan 8.
OBJECTIVE
To investigate the association between smoking status and pathological response to cisplatin-based neoadjuvant chemotherapy (NAC) and survival outcomes in patients with muscle-invasive bladder cancer (MIBC) treated with radical cystectomy (RC).
PATIENTS AND METHODS
We reviewed 201 patients treated with NAC and RC for cT2-cT4N0M0 BC between 01/1999 and 01/2015. Smoking status was categorised as: 'never', 'former', and 'current' smoker. Pathological response to NAC was defined as: complete (ypT0N0), partial (ypTis/Ta/T1, N0), and no response (ypT2-4 or ypN+). Clinicopathological characteristics were analysed according to smoking status. Logistic regression analyses tested the association between smoking status and pathological response to NAC. Cox regression analyses tested risk factors associated with recurrence, overall (OM) and cancer-specific mortality (CSM).
RESULTS
Overall, there were 58 (28.9%) never smokers, 87 (43.3%) former smokers, and 56 (27.9%) current smokers. No response to NAC was more frequently noted in current smokers (73.2%; P = 0.007). Former smoker (odds ratio [OR] 2.28; P = 0.024) and current smoker statuses (OR 4.52; P < 0.001) were significantly associated with no response to NAC, after adjusting for age, gender, Charlson Comorbidity Index, and clinical stage. Similarly, current smoking status (hazard ratio [HR] 2.14; P = 0.03) and extravesical pathological tumour stage (HR 3.31; P < 0.001) were independently associated with an increased risk of recurrence after RC.
CONCLUSION
Cigarette smoking was significantly associated with adverse pathological response to cisplatin-based NAC in patients with MIBC treated with RC. Current smokers were at significantly higher risk of disease recurrence as compared to former and never smokers.
目的
研究吸烟状况与顺铂为基础的新辅助化疗（NAC）病理反应及根治性膀胱切除术（RC）治疗肌层浸润性膀胱癌（MIBC）患者生存结局之间的关系。
方法
我们回顾了 201 例 1999 年 1 月至 2015 年 1 月接受 NAC 和 RC 治疗的 cT2-cT4N0M0BC 患者。吸烟状况分为：从不吸烟者、曾经吸烟者和当前吸烟者。NAC 病理反应定义为：完全缓解（ypT0N0）、部分缓解（ypTis/Ta/T1，N0）和无反应（ypT2-4 或 ypN+）。根据吸烟状况分析临床病理特征。Logistic 回归分析检验了吸烟状况与 NAC 病理反应之间的关系。Cox 回归分析检验了与复发、总生存期（OM）和癌症特异性死亡率（CSM）相关的危险因素。
结果
总体而言，有 58 例（28.9%）从不吸烟者、87 例（43.3%）曾经吸烟者和 56 例（27.9%）当前吸烟者。NAC 无反应者多见于当前吸烟者（73.2%；P=0.007）。在校正年龄、性别、Charlson 合并症指数和临床分期后，曾吸烟者（比值比[OR]2.28；P=0.024）和当前吸烟者（OR 4.52；P<0.001）与 NAC 无反应显著相关。同样，当前吸烟状况（危险比[HR]2.14；P=0.03）和膀胱外肿瘤分期（HR 3.31；P<0.001）与 RC 后复发风险增加独立相关。
结论
吸烟与 RC 治疗 MIBC 患者顺铂为基础的 NAC 不良病理反应显著相关。与曾经吸烟者和从不吸烟者相比，当前吸烟者疾病复发的风险显著增加。
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