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Smoke load prognostic impact on bacillus Calmette–Guérin (BCG) treated non-muscle invasive bladder cancer

  • Urology - Original Paper
  • Published:
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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

To the involved institution(s), the patients and those that provided and cared for study patients.

Funding

National Council for Scientific and Technological Development—CNPq, Research Productivity: 302622/2015–2 and 304747/2018–1 (Reis LO).

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Authors and Affiliations

  1. 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

    Danilo Leite Andrade, Tomas Bernardo Costa Moretti, Wilmar Azal Neto, Júlia Benedetti & Leonardo Oliveira Reis

Authors
  1. Danilo Leite Andrade
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  2. Tomas Bernardo Costa Moretti
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  3. Wilmar Azal Neto
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  4. Júlia Benedetti
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  5. Leonardo Oliveira Reis
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Contributions

DLA: data analysis, manuscript writing. TBCM: data analysis, manuscript writing. WAN: data analysis, manuscript writing. JB: data collection, manuscript editing. LOR: funding acquisition, supervision, and manuscript editing.

Corresponding author

Correspondence to Leonardo Oliveira Reis.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The local research ethics committee approved the protocol number 1.273.975.

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Andrade, D.L., Moretti, T.B.C., Neto, W.A. et al. Smoke load prognostic impact on bacillus Calmette–Guérin (BCG) treated non-muscle invasive bladder cancer. Int Urol Nephrol 52, 1471–1476 (2020). https://doi.org/10.1007/s11255-020-02438-6

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  • DOI: https://doi.org/10.1007/s11255-020-02438-6

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