Memorial Sloan Kettering Cancer Center, New York, New York.
J Urol. 2021 May;205(5):1321-1325. doi: 10.1097/JU.0000000000001571. Epub 2020 Dec 24.
Cigarette smoking is a risk factor for developing nonmuscle invasive bladder cancer, and continued smoking exposure after diagnosis may increase the likelihood of adverse clinical outcomes. We compare self-reported vs biochemically verified nicotine exposure to determine the accuracy of self-report among recently diagnosed nonmuscle invasive bladder cancer patients.
This cross-sectional analysis consisted of 517 nonmuscle invasive bladder cancer patients who contributed a urine or saliva specimen the same day as self-reporting their smoking, use of e-cigarettes, nicotine replacement therapy and whether they lived with a smoker. Cotinine, the primary metabolite of nicotine, was used as an objective biomarker of recent nicotine exposure.
The prevalence of high, low and no cotinine exposure was 13%, 54% and 33%, respectively. Overall, 7.3% of patients (38/517) reported being a current cigarette smoker, while 13% (65/517) had cotinine levels consistent with active smoking exposure. Of these 65 patients 27 denied current smoking, resulting in a sensitivity of self-reported current smoking of 58%. After considering other sources of nicotine exposure such as e-cigarettes, cigars, nicotine replacement therapy and living with a smoker, the sensitivity was higher, at 82%. Nearly all patients with low cotinine denied any smoking-related exposure.
Our findings suggest either biochemical verification with cotinine or additional questions about other sources of nicotine are needed to accurately identify nonmuscle invasive bladder cancer patients who have smoking-related exposures. Accurate classification of active and passive smoking exposure is essential to allow clinicians to advise cessation and help researchers estimate the association between post-diagnosis smoking-related exposure and nonmuscle invasive bladder cancer recurrence risk.
吸烟是罹患非肌层浸润性膀胱癌的一个风险因素，而确诊后持续的吸烟暴露可能会增加不良临床结局的发生概率。我们比较了自我报告和生物化学验证的尼古丁暴露情况，以确定在近期确诊的非肌层浸润性膀胱癌患者中自我报告的准确性。
这项横断面分析纳入了 517 名非肌层浸润性膀胱癌患者，他们在自我报告吸烟、使用电子烟、尼古丁替代疗法以及是否与吸烟者同住的同一天提供了尿液或唾液样本。尼古丁的主要代谢物可铁宁被用作近期尼古丁暴露的客观生物标志物。
高、低和无可铁宁暴露的患病率分别为 13%、54%和 33%。总体而言，7.3%（38/517）的患者报告目前为吸烟者，而 13%（65/517）的可铁宁水平与主动吸烟暴露一致。在这 65 名患者中，有 27 名否认目前吸烟，导致自我报告目前吸烟的敏感性为 58%。在考虑电子烟、雪茄、尼古丁替代疗法和与吸烟者同住等其他尼古丁来源后，敏感性更高，为 82%。几乎所有低可铁宁水平的患者都否认有任何与吸烟相关的暴露。
我们的研究结果表明，需要使用可铁宁进行生物化学验证或增加有关其他尼古丁来源的问题，以准确识别有吸烟相关暴露的非肌层浸润性膀胱癌患者。准确分类主动和被动吸烟暴露对于允许临床医生提供戒烟建议以及帮助研究人员估计确诊后与吸烟相关的暴露与非肌层浸润性膀胱癌复发风险之间的关联至关重要。
