Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil.
Int Urol Nephrol. 2020 Aug;52(8):1471-1476. doi: 10.1007/s11255-020-02438-6. Epub 2020 Mar 10.
Smoking habit is the major risk factor for bladder cancer (BC), related to about 50% of these tumors; however, the tobacco dose-effect impact on BC immune treatment is underexplored. This study evaluates the impact of smoke load on non-muscle invasive bladder cancer (NMIBC) prognosis after intravesical BCG.
Smoke load, recurrence, progression and disease-specific survival were evaluated in a retrospective study including NMIBC patients treated with intravesical BCG between 2006 and 2015. Multivariate Cox regression, ROC and Kaplan-Meier curves were utilized.
132 pT1 NMIBC patients were included: 95 (72%) males, mean age 69.6 ± 10.5 years and mean smoking pack-years 22.0 ± 20.8. Recurrence, progression and disease-specific death occurred in 69 (52.3%, mean 20.55 ± 20.44 months), 22 (16.7%, mean 31.39 ± 20.19 months) and 11 (8.3%, mean 37.23 ± 18.34 months), respectively. Smoke load significantly impacted recurrence, HR = 1.019 (95% CI 1.008-1.030, p = 0.0004), and progression, HR = 1.034 (95% CI 1.016-1.052, p = 0.0002), but not survival. For every 1-year increment in pack-years, the risk of relapse and progression increases by 1.9% and 3.4%, respectively. Over 20 pack-year showed the best predictive prognostic power.
The smoke load has a potential prognostic role in terms of recurrence and progression in the BCG treated NMIBC. Future studies should explore the smoking impact on the immune system, mainly beyond 20 pack-year.
吸烟习惯是膀胱癌（BC）的主要危险因素，约占这些肿瘤的 50%；然而，烟草剂量对 BC 免疫治疗的影响仍未得到充分探索。本研究评估了烟雾负荷对卡介苗（BCG）膀胱内治疗后非肌肉浸润性膀胱癌（NMIBC）预后的影响。
在一项回顾性研究中，评估了 2006 年至 2015 年间接受 BCG 膀胱内治疗的 NMIBC 患者的烟雾负荷、复发、进展和疾病特异性生存情况。利用多变量 Cox 回归、ROC 和 Kaplan-Meier 曲线进行分析。
共纳入 132 例 pT1NMIBC 患者：95 例（72%）为男性，平均年龄 69.6±10.5 岁，平均吸烟包年数为 22.0±20.8。复发、进展和疾病特异性死亡分别发生在 69 例（52.3%，平均 20.55±20.44 个月）、22 例（16.7%，平均 31.39±20.19 个月）和 11 例（8.3%，平均 37.23±18.34 个月）。烟雾负荷显著影响复发，HR=1.019（95%CI 1.008-1.030，p=0.0004）和进展，HR=1.034（95%CI 1.016-1.052，p=0.0002），但不影响生存。每增加 1 年的吸烟量，复发和进展的风险分别增加 1.9%和 3.4%。超过 20 包年显示出最佳的预测预后能力。
烟雾负荷在卡介苗治疗的 NMIBC 中具有潜在的复发和进展的预后作用。未来的研究应该探索吸烟对免疫系统的影响，特别是超过 20 包年的影响。
